Primary hepatocellular adenoma due to biallelic HNF1A mutations and its co-occurrence with MODY 3: case-report and review of the literature

Tong Wang,Junling Fu,Xinhua Xiao,Xiao Zhai

doi:10.1007/s12020-019-02138-x

Abstract

PurposeMaturity-onset diabetes of the young type 3 (MODY 3) is a consequence of heterozygous germline mutations in HNF1A, and a subtype of hepatocellular adenoma (HCA) is caused by biallelic somatic HNF1A mutations; rare HCA may be related to MODY 3. This study aimed to investigate the cosegregation of HNF1A mutations with diabetes and HCA in two families.MethodsTwo patients suffering from HCA and diabetes were screened for HNF1A germline and somatic mutations using direct sequence analysis and methylation-specific multiplex-ligation-dependent probe amplification (MS-MLPA) assay. Further, we screened eight relatives in the two independent families for diabetes, HCA and HNF1A variants. Additionally, we reviewed the literature concerning the phenotypes of MODY 3 and HCA at the background of HNF1A mutations.ResultsHere we reported two families (a total of six relatives) with two missense germline mutations of HNF1A identified initially using direct sequence analysis (c.686G>A in family A and c.526 + 1G>A in family B). Somatic deletion of the second allele of HNF1A was found in liver tumor tissues in both probands who were diagnosed with HCA. There are a total of ten cases of both MODY 3 and HCA phenotypes reported in the literature to date; incomplete penetrance for HCA was observed, and all the patients with HCA developed diabetes. The onset of diabetes and HCA was highly variable, the treatment of diabetes varied from diet to insulin, and the clinical expression of HCA ranged from silent to hemorrhage. Further, the severity of diabetes mellitus was not related to the occurrence of HCA.ConclusionsThis study describes the association of HCA and MODY 3 at the background of HNF1A mutations and highlights the importance of screening for HCA in MODY 3 families to avoid the possibility of severe complications. Further, the current study indicated that there may be a special mutational spectrum of HNF1A correlated with HCA in MODY 3 families.

Highlights

Supplementary information The online version of this article contains supplementary material, which is available to authorized users.Maturity-onset diabetes of the young (MODY) is an autosomal dominantly inherited type of diabetes that results from heterozygous mutations in various transcription factors acting in the development and function of pancreatic beta cells [1]
Maturity-onset diabetes of the young type 3 (MODY 3) is caused by inactivating germline heterozygous mutations in the hepatocyte nuclear factor 1a (HNF1A) gene, which accounts for nearly 2–5% of insulin independent diabetes and 30–65% of MODY and is characterized by positive glycosuria, microvascular complications tendency, and sulfonylurea priority [2]
Hepatocellular adenoma (HCA), which is known as a liver tumor characterized as being rare and benign, is widely believed to be related to oral contraception [3], and usually manifests as a single tumor, when several adenomas are discovered in one patient, this HCA is termed liver adenomatosis [4]

Summary

Introduction

Maturity-onset diabetes of the young (MODY) is an autosomal dominantly inherited type of diabetes that results from heterozygous mutations in various transcription factors acting in the development and function of pancreatic beta cells [1]. MODY 3 is caused by inactivating germline heterozygous mutations in the hepatocyte nuclear factor 1a (HNF1A) gene, which accounts for nearly 2–5% of insulin independent diabetes and 30–65% of MODY and is characterized by positive glycosuria, microvascular complications tendency, and sulfonylurea priority [2]. Mutations in HNF1A lead to decreased insulin secretion, and progressive damage of beta cells and cause the onset of diabetes. We hypothesized the existence of a relationship between HNF1A mutations and phenotypes of both MODY 3 and HCA, sometimes with the two pathologies appearing in the same individuals [6,7,8,9]. There have been four reports, and a total of ten cases showing the connections between the two phenotypes in subjects with HNF1A mutations

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