Landscape of Familial Isolated and Young-Onset Pituitary Adenomas: Prospective Diagnosis in AIP Mutation Carriers

Context: Familial isolated pituitary adenoma (FIPA) due to aryl hydrocarbon receptor interacting protein (Alp) gene mutations is an autosomal dominant disease with incomplete penetrance. Clinical screening of apparently unaffected AIP mutation (AIPmut) carriers could identify previously unrecognized disease. Objective: To determine the A/Pmutational status of FIPA and young pituitary adenoma patients, analyzing their clinical characteristics, and to perform clinical screening of apparently unaffected AlPmut carrier family members. Design: This was an observational, longitudinal study conducted over 7 years. Setting: International collaborative study conducted at referral centers for pituitary diseases. Participants: FIPA families (n = 216) and sporadic young-onset y) pituitary adenoma patients (n = 404) participated in the study. Interventions: We performed genetic screening of patients for A/Pmuts, clinical assessment of their family members, and genetic screening for somatic GNAS1 mutations and the germline FGFR4 p.G388R variant. Main Outcome Measure(s): We assessed clinical disease in mutation carriers, comparison of characteristics of A/Pmut positive and negative patients, results of GNAS1, and FGFR4 analysis. Results: Thirty-seven FIPA families and 34 sporadic patients had A/Pmuts. Patients with truncating A/Pmuts had a younger age at disease onset and diagnosis, compared with patients with nontruncating A/Pmuts. Somatic GNAS1 mutations were absent in tumors from A/Pmut-positive patients, and the studied FGFR4 variant did not modify the disease behavior or penetrance in A/Pmut-positive individuals. A total of 164 A/Pmut-positive unaffected family members were identified; pituitary disease was detected in 18 of those who underwent clinical screening. Conclusions: A quarter of the A/Pmut carriers screened were diagnosed with pituitary disease, justifying this screening and suggesting a variable clinical course for A/Pmut-positive pituitary adenomas.