Dysgenesis and Dysfunction of the Pancreas and Pituitary Due to FOXA2 Gene Defects

Context: Developmental disorders of the pituitary gland leading to congenital hypopituitarism can either be isolated or associated with extrapituitary abnormalities (syndromic hypopituitarism). A large number of syndromic hypopituitarism cases are linked to mutations in transcription factors. The forkhead box A2 (FOXA2) is a transcription factor that plays a key role in the central nervous system, foregut, and pancreatic development. Objective: This work aims to characterize 2 patients with syndromic hypopituitarism due to FOXA2 gene defects. Results: We report a novel heterozygous nonsense c.616C>T(p.Q206X) variant that leads to a truncated protein that lacks part of the DNA-binding domain of FOXA2, resulting in impaired transcriptional activation of the glucose transporter type 2 (GLUT2)-luciferase reporter. The patient is the sixth patient described in the literature with a FOXA2 mutation, and the first patient exhibiting pancreatic hypoplasia. We also report a second patient with a novel de novo 8.53 Mb deletion of 20p11.2 that encompasses FOXA2, who developed diabetes mellitus that responded to sulfonylurea treatment. Conclusion: Our 2 cases broaden the molecular and clinical spectrum of FOXA2-related disease, reporting the first nonsense mutation and the first case of pancreatic dysgenesis.

Automated summary

Our work characterizes 2 patients with syndromic hypopituitarism due to FOXA2 gene defects, including a novel heterozygous nonsense mutation and a novel de novo deletion that encompasses FOXA2. The first patient exhibited impaired transcriptional activation of GLUT2 due to the mutation, while the second patient developed diabetes mellitus that responded well to sulfonylurea treatment. This expands the molecular and clinical spectrum of FOXA2-related disease.