Clinical manifestations of highly prevalent corticosteroid-binding globulin mutations in a village in southern Italy

Giovanni Cizza, Livia Bernardi, Nicoletta Smirne, Raffaele Maletta, Carmine Tomaino, Angela Costanzo, Maura Gallo, John lewis, Silvana Geracitano, Maria Grasso, Guiseppe Potenza, Cosimo Monteleone, Giacomino Brancati, Jui Ting Ho, David Torpy, Amalia Bruni

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    Abstract

    Context: Corticosteroid-binding globulin (CBG) is the binding protein for cortisol. Rare kindreds with CBG mutations reducing CBG levels or altering binding affinity have been described, along with clinical manifestations encompassing fatigue, chronic pain, and hypotension. The largest kindred, exhibiting two mutations (null and Lyon) were Australian immigrants from Italy. Objective: Our objective was to determine the prevalence of the null/Lyon mutations in the village where the original null/Lyon family emigrated and compare subjects with and without CBG mutations, without previous knowledge of their mutation status. Design, Setting, and Participants: We conducted a survey field study that included 495 adult residents. Main Outcomes: We assessed clinical history, CBG mutation analysis, plasma CBG, salivary cortisol, body mass index, waist circumference, blood pressure, and the Krupp fatigue scale. Results: Eighteen of 495 participants (3.6%, seven males and 11 females) had one of two function-altering CBG mutations. All were heterozygous for the null (n = 6) or Lyon mutations (n = 12). Of 12 Lyon participants (four males and eight females), eight (two males and six females) had chronic widespread pain and five osteoarthritis with associated pain (one male and four females). Of six null participants (three males and three females), three (one male and two females) had chronic pain and four osteoarthritis with associated pain (two males and two females). Conclusions: A high combined prevalence (3.6%) of these two CBG mutations was detected. The presence of either mutation conferred a propensity to chronic pain. In other communities, individuals with the same genetic background complain more of fatigue than pain, suggesting an environmental effect on the phenotype. These findings,combined with animal CBG gene knockout and human CBG single-nucleotide polymorphism haplotype studies, suggest that CBG influences the endocrine and neurobehavioral response to stress, including the development of pain/fatigue syndromes.

    Original languageEnglish
    Pages (from-to)E1684-E1693
    Number of pages10
    JournalJournal of Clinical Endocrinology and Metabolism
    Volume96
    Issue number10
    DOIs
    Publication statusPublished - Oct 2011

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    Cizza, G., Bernardi, L., Smirne, N., Maletta, R., Tomaino, C., Costanzo, A., Gallo, M., lewis, J., Geracitano, S., Grasso, M., Potenza, G., Monteleone, C., Brancati, G., Ho, J. T., Torpy, D., & Bruni, A. (2011). Clinical manifestations of highly prevalent corticosteroid-binding globulin mutations in a village in southern Italy. Journal of Clinical Endocrinology and Metabolism, 96(10), E1684-E1693. https://doi.org/10.1210/jc.2011-1321