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Published in: Endocrine 1/2016

Open Access 01-07-2016 | Endocrine Genetics/Epigenetics

Glucocorticoid receptor polymorphisms modulate cardiometabolic risk factors in patients in long-term remission of Cushing’s syndrome

Authors: Sean H. P. P. Roerink, M. A. E. M. Wagenmakers, J. W. A. Smit, E. F. C. van Rossum, R. T. Netea-Maier, T. S. Plantinga, A. R. M. M. Hermus

Published in: Endocrine | Issue 1/2016

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Abstract

Context

Glucocorticoid receptor (GR) polymorphisms modulate glucocorticoid (GC) sensitivity and are associated with altered metabolic profiles.

Objective

To evaluate the presence of GR polymorphisms (BclI (rs41423247), N363S (rs56149945), ER22/23EK (rs6189/rs6190), and 9β (rs6198) and investigate their associations with metabolic alterations in patients in long-term remission of Cushing’s syndrome (CS).

Design and setting

Cross-sectional case–control study.

Patients and methods

Sixty patients in long-term remission of CS were genotyped. Associations between GR polymorphisms and multiple vascular, body composition and metabolic parameters were investigated.

Main outcome measures

Allelic frequencies of the polymorphisms and their associations with several cardiometabolic risk factors.

Results

This study shows that carriers of the 9β polymorphism have a higher systolic blood pressure and lower resistin levels. The GC sensitizing BclI polymorphism is associated with an adverse cardiometabolic risk factor profile: higher fat percentages of extremities and legs, higher serum leptin and E-selectin levels, and higher intima media thickness in carriers versus non-carriers.

Conclusions

The 9β and BclI polymorphisms of the GR adversely affect the cardiometabolic profile in patients who are in remission after the treatment of CS. This suggests that genetically altered GC sensitivity modulates the long-term adverse cardiometabolic effects resulting from (endogenous) hypercortisolism.
Literature
1.
go back to reference J. Lindholm, S. Juul, J.O. Jorgensen, J. Astrup, P. Bjerre, U. Feldt-Rasmussen, C. Hagen, J. Jorgensen, M. Kosteljanetz, L. Kristensen, P. Laurberg, K. Schmidt, J. Weeke, Incidence and late prognosis of cushing’s syndrome: a population-based study. J. Clin. Endocrinol. Metab. 86(1), 117–123 (2001)PubMed J. Lindholm, S. Juul, J.O. Jorgensen, J. Astrup, P. Bjerre, U. Feldt-Rasmussen, C. Hagen, J. Jorgensen, M. Kosteljanetz, L. Kristensen, P. Laurberg, K. Schmidt, J. Weeke, Incidence and late prognosis of cushing’s syndrome: a population-based study. J. Clin. Endocrinol. Metab. 86(1), 117–123 (2001)PubMed
2.
go back to reference G. Arnaldi, A. Angeli, A.B. Atkinson, X. Bertagna, F. Cavagnini, G.P. Chrousos, G.A. Fava, J.W. Findling, R.C. Gaillard, A.B. Grossman, B. Kola, A. Lacroix, T. Mancini, F. Mantero, J. Newell-Price, L.K. Nieman, N. Sonino, M.L. Vance, A. Giustina, M. Boscaro, Diagnosis and complications of Cushing’s syndrome: a consensus statement. J. Clin. Endocrinol. Metab. 88(12), 5593–5602 (2003)CrossRefPubMed G. Arnaldi, A. Angeli, A.B. Atkinson, X. Bertagna, F. Cavagnini, G.P. Chrousos, G.A. Fava, J.W. Findling, R.C. Gaillard, A.B. Grossman, B. Kola, A. Lacroix, T. Mancini, F. Mantero, J. Newell-Price, L.K. Nieman, N. Sonino, M.L. Vance, A. Giustina, M. Boscaro, Diagnosis and complications of Cushing’s syndrome: a consensus statement. J. Clin. Endocrinol. Metab. 88(12), 5593–5602 (2003)CrossRefPubMed
3.
go back to reference M. Wagenmakers, S. Roerink, L. Gil, T. Plantinga, J. Smit, R. Netea-Maier, A. Hermus, Persistent centripetal fat distribution and metabolic abnormalities in patients in long-term remission of Cushing’s syndrome. Clin. Endocrinol. 82(2), 180–187 (2015). doi:10.1111/cen.12639 CrossRef M. Wagenmakers, S. Roerink, L. Gil, T. Plantinga, J. Smit, R. Netea-Maier, A. Hermus, Persistent centripetal fat distribution and metabolic abnormalities in patients in long-term remission of Cushing’s syndrome. Clin. Endocrinol. 82(2), 180–187 (2015). doi:10.​1111/​cen.​12639 CrossRef
4.
go back to reference M.J. Barahona, N. Sucunza, E. Resmini, J.M. Fernandez-Real, W. Ricart, J.M. Moreno-Navarrete, T. Puig, J. Farrerons, S.M. Webb, Persistent body fat mass and inflammatory marker increases after long-term cure of Cushing’s syndrome. J. Clin. Endocrinol. Metab. 94(9), 3365–3371 (2009). doi:10.1210/jc.2009-0766 CrossRefPubMed M.J. Barahona, N. Sucunza, E. Resmini, J.M. Fernandez-Real, W. Ricart, J.M. Moreno-Navarrete, T. Puig, J. Farrerons, S.M. Webb, Persistent body fat mass and inflammatory marker increases after long-term cure of Cushing’s syndrome. J. Clin. Endocrinol. Metab. 94(9), 3365–3371 (2009). doi:10.​1210/​jc.​2009-0766 CrossRefPubMed
5.
go back to reference A. Colao, R. Pivonello, S. Spiezia, A. Faggiano, D. Ferone, M. Filippella, P. Marzullo, G. Cerbone, M. Siciliani, G. Lombardi, Persistence of increased cardiovascular risk in patients with Cushing’s disease after five years of successful cure. J. Clin. Endocrinol. Metab. 84(8), 2664–2672 (1999). doi:10.1210/jcem.84.8.5896 PubMed A. Colao, R. Pivonello, S. Spiezia, A. Faggiano, D. Ferone, M. Filippella, P. Marzullo, G. Cerbone, M. Siciliani, G. Lombardi, Persistence of increased cardiovascular risk in patients with Cushing’s disease after five years of successful cure. J. Clin. Endocrinol. Metab. 84(8), 2664–2672 (1999). doi:10.​1210/​jcem.​84.​8.​5896 PubMed
6.
go back to reference N.A. Huizenga, J.W. Koper, P. de Lange, H.A. Pols, R.P. Stolk, D.E. Grobbee, F.H. de Jong, S.W. Lamberts, Interperson variability but intraperson stability of baseline plasma cortisol concentrations, and its relation to feedback sensitivity of the hypothalamo-pituitary-adrenal axis to a low dose of dexamethasone in elderly individuals. J. Clin. Endocrinol. Metab. 83(1), 47–54 (1998)PubMed N.A. Huizenga, J.W. Koper, P. de Lange, H.A. Pols, R.P. Stolk, D.E. Grobbee, F.H. de Jong, S.W. Lamberts, Interperson variability but intraperson stability of baseline plasma cortisol concentrations, and its relation to feedback sensitivity of the hypothalamo-pituitary-adrenal axis to a low dose of dexamethasone in elderly individuals. J. Clin. Endocrinol. Metab. 83(1), 47–54 (1998)PubMed
7.
go back to reference E.F. van Rossum, S.W. Lamberts, Polymorphisms in the glucocorticoid receptor gene and their associations with metabolic parameters and body composition. Recent Prog. Horm. Res. 59, 333–357 (2004)CrossRefPubMed E.F. van Rossum, S.W. Lamberts, Polymorphisms in the glucocorticoid receptor gene and their associations with metabolic parameters and body composition. Recent Prog. Horm. Res. 59, 333–357 (2004)CrossRefPubMed
8.
go back to reference N.A. Huizenga, J.W. Koper, P. De Lange, H.A. Pols, R.P. Stolk, H. Burger, D.E. Grobbee, A.O. Brinkmann, F.H. De Jong, S.W. Lamberts, A polymorphism in the glucocorticoid receptor gene may be associated with and increased sensitivity to glucocorticoids in vivo. J. Clin. Endocrinol. Metab. 83(1), 144–151 (1998)PubMed N.A. Huizenga, J.W. Koper, P. De Lange, H.A. Pols, R.P. Stolk, H. Burger, D.E. Grobbee, A.O. Brinkmann, F.H. De Jong, S.W. Lamberts, A polymorphism in the glucocorticoid receptor gene may be associated with and increased sensitivity to glucocorticoids in vivo. J. Clin. Endocrinol. Metab. 83(1), 144–151 (1998)PubMed
9.
go back to reference A.M. Di Blasio, E.F. van Rossum, S. Maestrini, M.E. Berselli, M. Tagliaferri, F. Podesta, J.W. Koper, A. Liuzzi, S.W. Lamberts, The relation between two polymorphisms in the glucocorticoid receptor gene and body mass index, blood pressure and cholesterol in obese patients. Clin. Endocrinol. 59(1), 68–74 (2003)CrossRef A.M. Di Blasio, E.F. van Rossum, S. Maestrini, M.E. Berselli, M. Tagliaferri, F. Podesta, J.W. Koper, A. Liuzzi, S.W. Lamberts, The relation between two polymorphisms in the glucocorticoid receptor gene and body mass index, blood pressure and cholesterol in obese patients. Clin. Endocrinol. 59(1), 68–74 (2003)CrossRef
10.
go back to reference E.F. van Rossum, J.W. Koper, A.W. van den Beld, A.G. Uitterlinden, P. Arp, W. Ester, J.A. Janssen, A.O. Brinkmann, F.H. de Jong, D.E. Grobbee, H.A. Pols, S.W. Lamberts, Identification of the BclI polymorphism in the glucocorticoid receptor gene: association with sensitivity to glucocorticoids in vivo and body mass index. Clin. Endocrinol. 59(5), 585–592 (2003)CrossRef E.F. van Rossum, J.W. Koper, A.W. van den Beld, A.G. Uitterlinden, P. Arp, W. Ester, J.A. Janssen, A.O. Brinkmann, F.H. de Jong, D.E. Grobbee, H.A. Pols, S.W. Lamberts, Identification of the BclI polymorphism in the glucocorticoid receptor gene: association with sensitivity to glucocorticoids in vivo and body mass index. Clin. Endocrinol. 59(5), 585–592 (2003)CrossRef
11.
go back to reference E.F. van Rossum, J.W. Koper, N.A. Huizenga, A.G. Uitterlinden, J.A. Janssen, A.O. Brinkmann, D.E. Grobbee, F.H. de Jong, C.M. van Duyn, H.A. Pols, S.W. Lamberts, A polymorphism in the glucocorticoid receptor gene, which decreases sensitivity to glucocorticoids in vivo, is associated with low insulin and cholesterol levels. Diabetes 51(10), 3128–3134 (2002)CrossRefPubMed E.F. van Rossum, J.W. Koper, N.A. Huizenga, A.G. Uitterlinden, J.A. Janssen, A.O. Brinkmann, D.E. Grobbee, F.H. de Jong, C.M. van Duyn, H.A. Pols, S.W. Lamberts, A polymorphism in the glucocorticoid receptor gene, which decreases sensitivity to glucocorticoids in vivo, is associated with low insulin and cholesterol levels. Diabetes 51(10), 3128–3134 (2002)CrossRefPubMed
12.
go back to reference E.F. van Rossum, P.G. Voorhoeve, S.J. te Velde, J.W. Koper, H.A. Delemarre-van de Waal, H.C. Kemper, S.W. Lamberts, The ER22/23EK polymorphism in the glucocorticoid receptor gene is associated with a beneficial body composition and muscle strength in young adults. J. Clin. Endocrinol. Metab. 89(8), 4004–4009 (2004). doi:10.1210/jc.2003-031422 CrossRefPubMed E.F. van Rossum, P.G. Voorhoeve, S.J. te Velde, J.W. Koper, H.A. Delemarre-van de Waal, H.C. Kemper, S.W. Lamberts, The ER22/23EK polymorphism in the glucocorticoid receptor gene is associated with a beneficial body composition and muscle strength in young adults. J. Clin. Endocrinol. Metab. 89(8), 4004–4009 (2004). doi:10.​1210/​jc.​2003-031422 CrossRefPubMed
13.
go back to reference R.H. Oakley, C.M. Jewell, M.R. Yudt, D.M. Bofetiado, J.A. Cidlowski, The dominant negative activity of the human glucocorticoid receptor beta isoform. Specificity and mechanisms of action. J. Biol. Chem. 274(39), 27857–27866 (1999)CrossRefPubMed R.H. Oakley, C.M. Jewell, M.R. Yudt, D.M. Bofetiado, J.A. Cidlowski, The dominant negative activity of the human glucocorticoid receptor beta isoform. Specificity and mechanisms of action. J. Biol. Chem. 274(39), 27857–27866 (1999)CrossRefPubMed
14.
go back to reference R.H. Oakley, M. Sar, J.A. Cidlowski, The human glucocorticoid receptor beta isoform. Expression, biochemical properties, and putative function. J. Biol. Chem. 271(16), 9550–9559 (1996)CrossRefPubMed R.H. Oakley, M. Sar, J.A. Cidlowski, The human glucocorticoid receptor beta isoform. Expression, biochemical properties, and putative function. J. Biol. Chem. 271(16), 9550–9559 (1996)CrossRefPubMed
15.
go back to reference E.L. van den Akker, H. Russcher, E.F. van Rossum, A.O. Brinkmann, F.H. de Jong, A. Hokken, H.A. Pols, J.W. Koper, S.W. Lamberts, Glucocorticoid receptor polymorphism affects transrepression but not transactivation. J. Clin. Endocrinol. Metab. 91(7), 2800–2803 (2006). doi:10.1210/jc.2005-2119 CrossRefPubMed E.L. van den Akker, H. Russcher, E.F. van Rossum, A.O. Brinkmann, F.H. de Jong, A. Hokken, H.A. Pols, J.W. Koper, S.W. Lamberts, Glucocorticoid receptor polymorphism affects transrepression but not transactivation. J. Clin. Endocrinol. Metab. 91(7), 2800–2803 (2006). doi:10.​1210/​jc.​2005-2119 CrossRefPubMed
16.
go back to reference A.A. Syed, J.A. Irving, C.P. Redfern, A.G. Hall, N.C. Unwin, M. White, R.S. Bhopal, J.U. Weaver, Association of glucocorticoid receptor polymorphism A3669G in exon 9beta with reduced central adiposity in women. Obesity 14(5), 759–764 (2006). doi:10.1038/oby.2006.86 CrossRefPubMed A.A. Syed, J.A. Irving, C.P. Redfern, A.G. Hall, N.C. Unwin, M. White, R.S. Bhopal, J.U. Weaver, Association of glucocorticoid receptor polymorphism A3669G in exon 9beta with reduced central adiposity in women. Obesity 14(5), 759–764 (2006). doi:10.​1038/​oby.​2006.​86 CrossRefPubMed
17.
go back to reference E.L. van den Akker, J.W. Koper, E.F. van Rossum, M.J. Dekker, H. Russcher, F.H. de Jong, A.G. Uitterlinden, A. Hofman, H.A. Pols, J.C. Witteman, S.W. Lamberts, Glucocorticoid receptor gene and risk of cardiovascular disease. Arch. Intern. Med. 168(1), 33–39 (2008). doi:10.1001/archinternmed.2007.41 CrossRefPubMed E.L. van den Akker, J.W. Koper, E.F. van Rossum, M.J. Dekker, H. Russcher, F.H. de Jong, A.G. Uitterlinden, A. Hofman, H.A. Pols, J.C. Witteman, S.W. Lamberts, Glucocorticoid receptor gene and risk of cardiovascular disease. Arch. Intern. Med. 168(1), 33–39 (2008). doi:10.​1001/​archinternmed.​2007.​41 CrossRefPubMed
18.
go back to reference L. Trementino, G. Appolloni, C. Concettoni, M. Cardinaletti, M. Boscaro, G. Arnaldi, Association of glucocorticoid receptor polymorphism A3669G with decreased risk of developing diabetes in patients with Cushing’s syndrome. Eur.J. Endocrinal. 166(1), 35–42 (2012). doi:10.1530/EJE-11-0722 CrossRef L. Trementino, G. Appolloni, C. Concettoni, M. Cardinaletti, M. Boscaro, G. Arnaldi, Association of glucocorticoid receptor polymorphism A3669G with decreased risk of developing diabetes in patients with Cushing’s syndrome. Eur.J. Endocrinal. 166(1), 35–42 (2012). doi:10.​1530/​EJE-11-0722 CrossRef
19.
go back to reference A. Szappanos, A. Patocs, J. Toke, B. Boyle, M. Sereg, J. Majnik, G. Borgulya, I. Varga, I. Liko, K. Racz, M. Toth, BclI polymorphism of the glucocorticoid receptor gene is associated with decreased bone mineral density in patients with endogenous hypercortisolism. Clin. Endocrinol. 71(5), 636–643 (2009). doi:10.1111/j.1365-2265.2009.03528.x CrossRef A. Szappanos, A. Patocs, J. Toke, B. Boyle, M. Sereg, J. Majnik, G. Borgulya, I. Varga, I. Liko, K. Racz, M. Toth, BclI polymorphism of the glucocorticoid receptor gene is associated with decreased bone mineral density in patients with endogenous hypercortisolism. Clin. Endocrinol. 71(5), 636–643 (2009). doi:10.​1111/​j.​1365-2265.​2009.​03528.​x CrossRef
20.
go back to reference O. Ragnarsson, C. Glad, P. Berglund, R. Bergthorsdottir, D.N. Eder, G. Johannsson, Common genetic variants in the glucocorticoid receptor and the 11beta-Hydroxysteroid dehydrogenase type 1 genes influence long-term cognitive impairments in patients with Cushing’s syndrome in remission. J. Clin. Endocrinol. Metab. (2014). doi:10.1210/jc.2014-1906 O. Ragnarsson, C. Glad, P. Berglund, R. Bergthorsdottir, D.N. Eder, G. Johannsson, Common genetic variants in the glucocorticoid receptor and the 11beta-Hydroxysteroid dehydrogenase type 1 genes influence long-term cognitive impairments in patients with Cushing’s syndrome in remission. J. Clin. Endocrinol. Metab. (2014). doi:10.​1210/​jc.​2014-1906
21.
22.
go back to reference M.E. Molitch, D.R. Clemmons, S. Malozowski, G.R. Merriam, S.M. Shalet, M.L. Vance, S. Endocrine Society’s Clinical Guidelines, P.A. Stephens, Evaluation and treatment of adult growth hormone deficiency: an endocrine society clinical practice guideline. J. Clin. Endocrinol. Metab. 91(5), 1621–1634 (2006). doi:10.1210/jc.2005-2227 M.E. Molitch, D.R. Clemmons, S. Malozowski, G.R. Merriam, S.M. Shalet, M.L. Vance, S. Endocrine Society’s Clinical Guidelines, P.A. Stephens, Evaluation and treatment of adult growth hormone deficiency: an endocrine society clinical practice guideline. J. Clin. Endocrinol. Metab. 91(5), 1621–1634 (2006). doi:10.​1210/​jc.​2005-2227
24.
go back to reference D.R. Matthews, J.P. Hosker, A.S. Rudenski, B.A. Naylor, D.F. Treacher, R.C. Turner, Homeostasis model assessment: insulin resistance and beta-cell function from fasting plasma glucose and insulin concentrations in man. Diabetologia 28(7), 412–419 (1985)CrossRefPubMed D.R. Matthews, J.P. Hosker, A.S. Rudenski, B.A. Naylor, D.F. Treacher, R.C. Turner, Homeostasis model assessment: insulin resistance and beta-cell function from fasting plasma glucose and insulin concentrations in man. Diabetologia 28(7), 412–419 (1985)CrossRefPubMed
26.
go back to reference B.L. Wajchenberg, D. Giannella-Neto, M.E. da Silva, R.F. Santos, Depot-specific hormonal characteristics of subcutaneous and visceral adipose tissue and their relation to the metabolic syndrome. Horm Metab Res 34(11–12), 616–621 (2002). doi:10.1055/s-2002-38256 CrossRefPubMed B.L. Wajchenberg, D. Giannella-Neto, M.E. da Silva, R.F. Santos, Depot-specific hormonal characteristics of subcutaneous and visceral adipose tissue and their relation to the metabolic syndrome. Horm Metab Res 34(11–12), 616–621 (2002). doi:10.​1055/​s-2002-38256 CrossRefPubMed
27.
go back to reference O. Ragnarsson, C.A. Glad, R. Bergthorsdottir, E.G. Almqvist, E. Ekerstad, H. Widell, B. Wangberg, G. Johannsson, Body composition and bone mineral density in women with Cushing’s syndrome in remission and the association with common genetic variants influencing glucocorticoid sensitivity. Eur. J. Endocrinol. 172(1), 1–10 (2015). doi:10.1530/EJE-14-0747 CrossRefPubMed O. Ragnarsson, C.A. Glad, R. Bergthorsdottir, E.G. Almqvist, E. Ekerstad, H. Widell, B. Wangberg, G. Johannsson, Body composition and bone mineral density in women with Cushing’s syndrome in remission and the association with common genetic variants influencing glucocorticoid sensitivity. Eur. J. Endocrinol. 172(1), 1–10 (2015). doi:10.​1530/​EJE-14-0747 CrossRefPubMed
28.
Metadata
Title
Glucocorticoid receptor polymorphisms modulate cardiometabolic risk factors in patients in long-term remission of Cushing’s syndrome
Authors
Sean H. P. P. Roerink
M. A. E. M. Wagenmakers
J. W. A. Smit
E. F. C. van Rossum
R. T. Netea-Maier
T. S. Plantinga
A. R. M. M. Hermus
Publication date
01-07-2016
Publisher
Springer US
Published in
Endocrine / Issue 1/2016
Print ISSN: 1355-008X
Electronic ISSN: 1559-0100
DOI
https://doi.org/10.1007/s12020-016-0883-z

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