Abstract
Glucocorticoid resistance is a rare condition characterized by generalized, partial,
target-tissue insensitivity to glucocorticoids. Compensatory elevations in circulating
adrenocorticotropic hormone (ACTH) concentrations lead to increased secretion of cortisol
and adrenal steroids with mineralocorticoid and/or androgenic activity, but no clinical
evidence of hypercortisolism. The clinical spectrum of the condition is broad, ranging
from asymptomatic to severe cases of hyperandrogenism, fatigue and/or mineralocorticoid
excess. The molecular basis of glucocorticoid resistance has been ascribed to mutations
in the human glucocorticoid receptor (hGR) gene, which impair glucocorticoid signal
transduction, thereby altering tissue sensitivity to glucocorticoids. The study of
functional defects of natural hGR mutants enhances our understanding of the molecular
mechanisms of hGR action and highlights the importance of integrated cellular and
molecular signaling mechanisms for maintaining homeostasis and preserving normal physiology.
Key words
Glucocorticoid receptor (GR) - glucocorticoid resistance - mutations - human glucocorticoid
receptor (hGR) gene
References
1
Vingerhoeds AC, Thijssen JH, Schwarz F.
Spontaneous hypercortisolism without Cushing's syndrome.
J Clin Endocrinol Metab.
1976;
43
1128-1133
2
Chrousos GP, Vingerhoeds A, Brandon D, Eil C, Pugeat M, DeVroede M, Loriaux DL, Lipsett MB.
Primary cortisol resistance in man. A glucocorticoid receptor-mediated disease.
J Clin Invest.
1982;
69
1261-1269
3
Chrousos GP, Detera-Wadleigh SD, Karl M.
Syndromes of glucocorticoid resistance.
Ann Intern Med.
1993;
119
1113-1124
4
Kino T, Chrousos GP.
Glucocorticoid and mineralocorticoid resistance/hypersensitivity syndromes.
J Endocrinol.
2001;
169
437-445
5 Chrousos GP. Hormone Resistance and Hypersensitivity States. In: Modern Endocrinology
Series. Chrousos GP, Olefsky JM, Samols E (eds). Philadelphia, PA: Lippincott, Williams
& Wilkins 2002: 542
6
Kino T, Vottero A, Charmandari E, Chrousos GP.
Familial/sporadic glucocorticoid resistance syndrome and hypertension.
Ann N Y Acad Sci.
2002;
970
101-111
7
Kino T, De Martino MU, Charmandari E, Mirani M, Chrousos GP.
Tissue glucocorticoid resistance/hypersensitivity syndromes.
J Steroid Biochem Mol Biol.
2003;
85
457-467
8
Charmandari E, Kino T, Chrousos GP.
Familial/sporadic glucocorticoid resistance: clinical phenotype and molecular mechanisms.
Ann N Y Acad Sci.
2004;
1024
168-181
9
Karl M, Lamberts SW, Koper JW, Katz DA, Huizenga NE, Kino T, Haddad BR, Hughes MR,
Chrousos GP.
Cushing's disease preceded by generalized glucocorticoid resistance: clinical consequences
of a novel, dominant-negative glucocorticoid receptor mutation.
Proc Assoc Am Physicians.
1996;
108
296-307
10
Hurley DM, Accili D, Stratakis CA, Karl M, Vamvakopoulos N, Rorer E, Constantine K,
Taylor SI, Chrousos GP.
Point mutation causing a single amino acid substitution in the hormone binding domain
of the glucocorticoid receptor in familial glucocorticoid resistance.
J Clin Invest.
1991;
87
680-686
11
Karl M, Lamberts SW, Detera-Wadleigh SD, Encio IJ, Stratakis CA, Hurley DM, Accili D,
Chrousos GP.
Familial glucocorticoid resistance caused by a splice site deletion in the human glucocorticoid
receptor gene.
J Clin Endocrinol Metab.
1993;
76
683-689
12
Malchoff DM, Brufsky A, Reardon G, McDermott P, Javier EC, Bergh CH, Rowe D, Malchoff CD.
A mutation of the glucocorticoid receptor in primary cortisol resistance.
J Clin Invest.
1993;
91
1918-1925
13
Kino T, Stauber RH, Resau JH, Pavlakis GN, Chrousos GP.
Pathologic human GR mutant has a transdominant negative effect on the wild-type GR
by inhibiting its translocation into the nucleus: importance of the ligand-binding
domain for intracellular GR trafficking.
J Clin Endocrinol Metab.
2001;
86
5600-5608
14
Ruiz M, Lind U, Gafvels M, Eggertsen G, Carlstedt-Duke J, Nilsson L, Holtmann M, Stierna P,
Wikstrom AC, Werner S.
Characterization of two novel mutations in the glucocorticoid receptor gene in patients
with primary cortisol resistance.
Clin Endocrinol (Oxf).
2001;
55
363-371
15
Mendonca BB, Leite MV, de Castro M, Kino T, Elias LL, Bachega TA, Arnhold IJ, Chrousos GP,
Latronico AC.
Female pseudohermaphroditism caused by a novel homozygous missense mutation of the
GR gene.
J Clin Endocrinol Metab.
2002;
87
1805-1809
16
Vottero A, Kino T, Combe H, Lecomte P, Chrousos GP.
A novel, C-terminal dominant negative mutation of the GR causes familial glucocorticoid
resistance through abnormal interactions with p160 steroid receptor coactivators.
J Clin Endocrinol Metab.
2002;
87
2658-2667
17
Charmandari E, Kino T, Vottero A, Souvatzoglou E, Bhattacharyya N, Chrousos GP.
Natural glucocorticoid receptor mutants causing generalized glucocorticoid resistance:
Molecular genotype, genetic transmission and clinical phenotype.
J Clin Endocrinol Metab.
2004;
89
1939-1949
18
Charmandari E, Kino T, Ichijo T, Zachman K, Alatsatianos A, Chrousos GP.
Functional characterization of the natural human glucocorticoid receptor (hGR) mutants
hGRalphaR477 H and hGRalphaG679S associated with generalized glucocorticoid resistance.
J Clin Endocrinol Metab.
2006;
91
1535-1543
19
Charmandari E, Raji A, Kino T, Ichijo T, Tiulpakov A, Zachman K, Chrousos GP.
A novel point mutation in the ligand-binding domain (LBD) of the human glucocorticoid
receptor (hGR) causing generalized glucocorticoid resistance: the importance of the
C terminus of hGR LBD in conferring transactivational activity.
J Clin Endocrinol Metab.
2005;
90
3696-3705
20
Bledsoe RK, Montana VG, Stanley TB, Delves CJ, Apolito CJ, McKee DD, Consler TG, Parks DJ,
Stewart EL, Willson TM, Lambert MH, Moore JT, Pearce KH, Xu HE.
Crystal structure of the glucocorticoid receptor ligand binding domain reveals a novel
mode of receptor dimerization and coactivator recognition.
Cell.
2002;
110
93-105
21
Kauppi B, Jakob C, Farnegardh M, Yang J, Ahola H, Alarcon M, Calles K, Engstrom O,
Harlan J, Muchmore S, Ramqvist AK, Thorell S, Ohman L, Greer J, Gustafsson JA, Carlstedt-Duke J,
Carlquist M.
The three-dimensional structures of antagonistic and agonistic forms of the glucocorticoid
receptor ligand-binding domain: RU-486 induces a transconformation that leads to active
antagonism.
J Biol Chem.
2003;
278
22748-22754
22 Charmandari E, Kino T, Ichijo T, Jubiz W, Zachman K, Mejia L, Chrousos GP. A novel
point mutation in Helix 11 of the ligand-binding domain of the human glucocorticoid
receptor gene causing generalized glucocorticoid resistance.
Poster presentation at the 88th Endocrine Society Annual Meeting . 2006 Boston, Massachusetts, USA
Correspondence
E. CharmandariMD
Consultant Pediatric and Adolescent Endocrinologist
Level B, Room 134
Clarendon Wing
Leeds General Infirmary
Belmont Grove
Leeds LS2 9NS
UK
Phone: +44/113/392 37 00
Fax: +44/113/392 32 25
Email: evangelia.charmandari@googlemail.com