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Glucocorticoid receptor and molecular chaperones in the pathogenesis of adrenal incidentalomas: potential role of reduced sensitivity to glucocorticoids.
[adrenal incidentaloma]
Glucocorticoid
(
GC
)
sensitivity
depends
on
glucocorticoid
receptor
(
GR
)
and
heat
shock
proteins
(
Hsps
)
.
We
investigated
whether
common
GR
genes
(
ER
22
/
23
EK
,
N
363
S
,
Bcl
I
,
and
9
β
)
and
adrenocorticotropin
receptor
promoter
polymorphisms
influence
susceptibility
for
unilateral
adrenal
incidentaloma
(
AI
)
,
plus
GR
and
Hsp
expression
in
tumorous
(
n
=
19
)
,
peritumorous
(
n
=
13
)
and
normal
adrenocortical
(
n
=
11
)
tissues
.
Patients
(
n
=
112
)
,
population-matched
controls
(
n
=
100
)
and
tumor
tissues
(
n
=
32
)
were
genotyped
for
these
polymorphisms
.
Postdexamethasone
serum
cortisol
was
higher
in
patients
(
p
<
0
.
001
)
.
GR
gene
variants
,
larger
allele
of
Bcl
I
(
odds
ratio
[
OR
]
2
.
9
;
95
%
confidence
interval
[
CI
]
1
.
7
-
5
.
1
;
p
<
0
.
001
]
and
minor
allele
of
9
β
(
OR
3
.
0
;
95
%
CI
1
.
6
-
5
.
7
;
p
<
0
.
001
)
were
independent
predictors
of
AI
.
In
patients
,
the
first
allele
is
linked
with
larger
tumors
(
p
=
0
.
002
)
and
the
latter
with
higher
postdexamethasone
cortisol
levels
(
p
=
0
.
025
)
.
Both
allele
carriers
had
lesser
waist
circumference
(
p
=
0
.
02
)
,
similar
adrenocorticotropin
and
higher
basal
(
p
=
0
.
024
)
and
postdexamethasone
cortisol
concentrations
(
p
<
0
.
001
)
.
Tumorous
and
constitutional
genotypes
were
similar
.
GR-D
is
the
major
receptor
isoform
in
normal
adrenal
cortex
by
Western
blotting
.
Loss
of
other
receptor
isoforms
,
decrease
in
immunostaining
for
GR
(
p
<
0
.
0001
)
,
underexpression
of
chaperones
(
p
≤
0
.
01
)
and
the
presence
of
inducible
Hsp
70
were
found
in
adenomas
.
In
conclusion
,
GR
gene
variants
,
C
allele
of
Bcl
I
and
minor
allele
of
9
β
,
are
associated
with
AIs
.
Their
concurrent
presence
in
patients
reduces
GC
sensitivity
.
Normal
adrenal
cortex
preferentially
expresses
GR-D
.
In
adenomas
,
the
lack
of
other
GR
isoforms
and
underexpression
of
heat
shock
proteins
perhaps
permanently
impair
GC
signaling
,
which
could
promote
dysregulated
cortisol
production
and
tumor
growth
.
The
innate
GC
sensitivity
probably
modifies
these
effects
.
Diseases
Validation
Diseases presenting
"tumor growth"
symptom
adrenal incidentaloma
carcinoma of the gallbladder
cholangiocarcinoma
cowden syndrome
cystinuria
esophageal adenocarcinoma
esophageal carcinoma
esophageal squamous cell carcinoma
hodgkin lymphoma, classical
liposarcoma
lymphangioleiomyomatosis
primary effusion lymphoma
severe combined immunodeficiency
von hippel-lindau disease
waldenström macroglobulinemia
wiskott-aldrich syndrome
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