Somatic and Germline CACNA1D Calcium Channel Mutations in Aldosterone-producing Adenomas and Primary Aldosteronism


Adrenal aldosterone-producing adenomas (APAs) constitutively produce the salt-retaining hormone aldosterone and are a common cause of severe hypertension. Recurrent mutations in the potassium channel KCNJ5 that result in cell depolarization and Ca2+ influx cause ~40% of these tumors. We found five somatic mutations (four altering glycine 403, one altering isoleucine 770) in CACNA1D, encoding a voltage-gated calcium channel, among 43 non-KCNJ5-mutant APAs. These mutations lie in S6 segments that line the channel pore. Both result in channel activation at less depolarized potentials, and glycine 403 mutations also impair channel inactivation. These effects are inferred to cause increased Ca2+ influx, the sufficient stimulus for aldosterone production and cell proliferation in adrenal glomerulosa. Remarkably, we identified de novo mutations at the identical positions in two children with a previously undescribed syndrome featuring primary aldosteronism and neuromuscular abnormalities. These findings implicate gain of function Ca2+ channel mutations in aldosterone-producing adenomas and primary aldosteronism.

Authors: Ute I. Scholl, Gerald Goh, Gabriel Stölting, Regina Campos de Oliveira, Murim Choi, John D. Overton, Annabelle L. Fonseca, Reju Korah, Lee F. Starker, John W. Kunstman, Manju L. Prasad, Erum A. Hartung, Nelly Mauras, Matthew R. Benson, Tammy Brady, Jay R. Shapiro, Erin Loring, Carol Nelson-Williams, Steven K. Libutti, Shrikant Mane, Per Hellman, Gunnar Westin, Göran Åkerström, Peyman Björklund, Tobias Carling, Christoph Fahlke, Patricia Hidalgo, Richard P. Lifton
Keywords: CACNA1D, cerebral palsy, seizure
DOI Number: 10.1038/ng.2695      Publication Year: 2013

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