European Journal of Pediatrics

, Volume 170, Issue 8, pp 1017–1021 | Cite as

A novel mutation of LHX3 is associated with combined pituitary hormone deficiency including ACTH deficiency, sensorineural hearing loss, and short neck—a case report and review of the literature

Original Paper

Abstract

The LHX3 LIM-homeodomain transcription factor gene is required for normal pituitary and motoneuron development. LHX3 mutations are associated with growth hormone, prolactin, gonadotropin, and TSH deficiency; abnormal pituitary morphology; and may be accompanied with limited neck rotation and sensorineural hearing loss. We report on a boy, who presented with hypoglycemia in the newborn period. He is the second child of healthy unrelated parents. Short neck, growth hormone deficiency, and central hypothyroidism were diagnosed at a general pediatric hospital. Growth hormone and levothyroxine treatment were started, and blood sugar normalized with this treatment. On cerebral MRI, the anterior pituitary gland was hypoplastic. Sensorineural hearing loss was diagnosed by auditory testing. During follow-up, six repeatedly low morning cortisol levels (<1 μg/dl) and low ACTH levels (<10 pg/ml) were documented, so ACTH deficiency had developed over time and therefore hydrocortisone replacement was started at 1.5 years of age. Mutation analysis of the LHX3 gene revealed a homozygous stop mutation in exon 2: c.229C>T (CGA > TGA), Arg77stop (R77X). A complete loss of function is assumed with this homozygous stop mutation. We report a novel LHX3 mutation, which is associated with combined pituitary hormone deficiency including ACTH deficiency, short neck, and sensorineural hearing loss. All patients with LHX3 defects should undergo longitudinal screening for ACTH deficiency, since corticotrope function may decline over time. All patients should have auditory testing to allow for regular speech development.

Keywords

LHX3 Pituitary hormone deficiency ACTH deficiency Sensorineural hearing loss 

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Copyright information

© Springer-Verlag 2011

Authors and Affiliations

  1. 1.Kinderklinik und Kinderpoliklinik Schwabing Department of Pediatric EndocrinologyTechnische Universität MünchenMünchenGermany
  2. 2.Institute of Experimental Pediatric EndocrinologyCharité BerlinBerlinGermany
  3. 3.Pediatric Endocrinology, Dr. von Haunesrches Kinderspital, Ludwig MaximiliansUniversität MünchenMünchenGermany

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