{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T01:01:25Z","timestamp":1760058085889,"version":"build-2065373602"},"reference-count":56,"publisher":"MDPI AG","issue":"3","license":[{"start":{"date-parts":[[2025,3,14]],"date-time":"2025-03-14T00:00:00Z","timestamp":1741910400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Children"],"abstract":"<jats:p>Background: Multiple genes can disrupt hypothalamic\u2013pituitary axis development, causing multiple pituitary hormone deficiencies (MPHD). Despite advances in next-generation sequencing (NGS) identifying over 30 key genes, 85% of cases remain unsolved, indicating complex genotype\u2013phenotype correlations and variable inheritance patterns. Objective: This study aimed to identify the MPHD genetics in three probands from two unrelated families. Methods: Family A had one affected child, while Family B had two affected siblings. All probands exhibited poor growth since birth, and family B\u2019s probands were born small for gestational age. Growth hormone deficiency was confirmed in all subjects. Family B\u2019s probands responded poorly to growth hormone treatment compared to the first patient. Furthermore, Family A\u2019s proband and Family B\u2019s younger sibling developed central hypothyroidism, while Family B\u2019s older sibling presented hypogonadotropic hypogonadism. Brain magnetic resonance imaging (MRI) revealed pituitary hypoplasia, ectopic posterior pituitary gland, and small sella turcica in all probands. Patients and their available relatives underwent NGS. Results: NGS identified the same novel and likely pathogenic LHX4 variant (c.481C&gt;G) in all probands despite the families being unrelated. Additionally, Family A\u2019s proband carried a GLI2 variant (c.2105C&gt;A), and Family B\u2019s probands carried an IGF1R variant (c.166G&gt;A), both interpreted as being of uncertain significance. Conclusions: This study confirms that heterozygous pathogenic variants of LHX4 can cause MPHD associated with a specific neuroradiological triad of abnormalities despite incomplete penetrance and variable phenotype. Moreover, the co-occurrence of the other two gene variants was debated. The IGF1R variant could explain the unusually poor response to growth hormone therapy in Family B, suggesting an oligogenic mechanism underlying the phenotype.<\/jats:p>","DOI":"10.3390\/children12030364","type":"journal-article","created":{"date-parts":[[2025,3,14]],"date-time":"2025-03-14T13:07:51Z","timestamp":1741957671000},"page":"364","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["A Novel Missense Variant in LHX4 in Three Children with Multiple Pituitary Hormone Deficiency Belonging to Two Unrelated Families and Contribution of Additional GLI2 and IGFR1 Variant"],"prefix":"10.3390","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4547-0500","authenticated-orcid":false,"given":"Claudia","family":"Santoro","sequence":"first","affiliation":[{"name":"Department of Child, Woman, General and Specialized Surgery, University of Campania \u201cL. Vanvitelli\u201d, L. De Crecchio 4 Street, 80138 Naples, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Francesca","family":"Aiello","sequence":"additional","affiliation":[{"name":"Department of Child, Woman, General and Specialized Surgery, University of Campania \u201cL. Vanvitelli\u201d, L. De Crecchio 4 Street, 80138 Naples, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Antonella","family":"Farina","sequence":"additional","affiliation":[{"name":"Department of Precision Medicine, University of Campania \u201cLuigi Vanvitelli\u201d, Sant\u2019Andrea delle Dame Square L. De Crecchio 7 Street, 80138 Naples, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9410-5393","authenticated-orcid":false,"given":"Emanuele","family":"Miraglia del Giudice","sequence":"additional","affiliation":[{"name":"Department of Child, Woman, General and Specialized Surgery, University of Campania \u201cL. Vanvitelli\u201d, L. De Crecchio 4 Street, 80138 Naples, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Filomena","family":"Pascarella","sequence":"additional","affiliation":[{"name":"Pediatric Endocrinology Unit, Sant\u2019Anna e San Sebastiano Hospital, Palasciano Street, 81100 Caserta, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Maria Rosaria","family":"Licenziati","sequence":"additional","affiliation":[{"name":"Neuro-Endocrine Diseases and Obesity Unit, Department of Neurosciences, Santobono-Pausilipon Children\u2019s Hospital, Via Egiziaca a Forcella, 18, 80139 Naples, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4235-0917","authenticated-orcid":false,"given":"Nicola","family":"Improda","sequence":"additional","affiliation":[{"name":"Neuro-Endocrine Diseases and Obesity Unit, Department of Neurosciences, Santobono-Pausilipon Children\u2019s Hospital, Via Egiziaca a Forcella, 18, 80139 Naples, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9418-125X","authenticated-orcid":false,"given":"Giulio","family":"Piluso","sequence":"additional","affiliation":[{"name":"Department of Precision Medicine, University of Campania \u201cLuigi Vanvitelli\u201d, Sant\u2019Andrea delle Dame Square L. De Crecchio 7 Street, 80138 Naples, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2479-6018","authenticated-orcid":false,"given":"Annalaura","family":"Torella","sequence":"additional","affiliation":[{"name":"Department of Precision Medicine, University of Campania \u201cLuigi Vanvitelli\u201d, Sant\u2019Andrea delle Dame Square L. De Crecchio 7 Street, 80138 Naples, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9454-2964","authenticated-orcid":false,"given":"Francesca","family":"Del Vecchio Blanco","sequence":"additional","affiliation":[{"name":"Department of Precision Medicine, University of Campania \u201cLuigi Vanvitelli\u201d, Sant\u2019Andrea delle Dame Square L. De Crecchio 7 Street, 80138 Naples, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5350-7700","authenticated-orcid":false,"given":"Mario","family":"Cirillo","sequence":"additional","affiliation":[{"name":"Advanced MRI Neuroimaging Centre, Department of Advanced Medical and Surgical Sciences, University of Campania \u201cLuigi Vanvitelli\u201d, Sant\u2019Andrea delle Dame Square, 80138 Naples, Italy"},{"name":"MRI Research Center SUN-FISM, University of Campania \u201cLuigi Vanvitelli\u201d, Sant\u2019Andrea delle Dame Square, 80138 Naples, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Vincenzo","family":"Nigro","sequence":"additional","affiliation":[{"name":"Department of Precision Medicine, University of Campania \u201cLuigi Vanvitelli\u201d, Sant\u2019Andrea delle Dame Square L. De Crecchio 7 Street, 80138 Naples, Italy"},{"name":"Telethon Institute of Genetics and Medicine (TIGEM), Via Campi Flegrei 34, 80078 Pozzuoli, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Anna","family":"Grandone","sequence":"additional","affiliation":[{"name":"Department of Child, Woman, General and Specialized Surgery, University of Campania \u201cL. Vanvitelli\u201d, L. De Crecchio 4 Street, 80138 Naples, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2025,3,14]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"19","DOI":"10.1016\/j.ghir.2017.10.005","article-title":"Progression from isolated growth hormone deficiency to combined pituitary hormone deficiency","volume":"37","author":"Cerbone","year":"2017","journal-title":"Growth Horm. 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