Cited by 336Hypothalamic control of reproductive hormonesPituitary Gland Disorders and TreatmentsSexual Differentiation and Disorders

The DOI matches its Crossref record; 75 of the 77 references it cites were found in a registry or an index; none of the 109 sources its claims cite is checked for support yet.

The genetic and molecular basis of idiopathic hypogonadotropic hypogonadism

Open access
Bianco, Suzy D. C., Kaiser, Ursula B.·2009·Nature Reviews Endocrinology

Abstract

Idiopathic hypogonadotropic hypogonadism (IHH) has an incidence of 1–10 cases per 100,000 births. About 60% of patients with IHH present with associated anosmia, also known as Kallmann syndrome, characterized by total or partial loss of olfaction. Many of the gene mutations associated with Kallmann syndrome have been mapped to KAL1 or FGFR1. However, together, these mutations account for only about 15% of Kallmann syndrome cases. More recently, mutations in PROK2 and PROKR2 have been linked to the syndrome and may account for an additional 5–10% of cases. The remaining 40% of patients with IHH have a normal sense of smell. Prior to 2003, the only gene linked to normosmic IHH was the gonadotropin-releasing hormone receptor gene. However, mutations in this receptor are believed to account for only 10% of cases. Subsequently, mutations in KISS1R, TAC3 and TACR3 were identified as causes of normosmic IHH. Certain genes, including PROK2 and FGFR1, are associated with both anosmic and normosmic IHH. Despite recent advances in the field, the genetic causes of the majority of cases of IHH remain unknown. This Review discusses genes associated with hypogonadotropic disorders and the molecular mechanisms by which mutations in these genes may result in IHH.

Overview

AI snapshot

Written from the paper’s full text.

TL;DR

This review summarizes the genetic and molecular basis of idiopathic hypogonadotropic hypogonadism (IHH), including Kallmann syndrome and normosmic IHH, organized by effects on GnRH neuron migration, secretion, and action. Despite identifying multiple causal genes, it concludes that the genetic basis of the vast majority of IHH cases remains unknown.

Key findings

  • IHH has an incidence of 1–10 cases per 100,000 births; about 60% of patients have anosmia (Kallmann syndrome). KAL1 and FGFR1 mutations together account for only about 15% of Kallmann syndrome cases, while PROK2/PROKR2 mutations may account for an additional 5–10%.
  • In normosmic IHH, GNRHR mutations account for 3.5–16% of sporadic cases and up to 40% of familial cases; KISS1R mutations represent about 5%, LEP/LEPR mutations less than 5%, and CHD7 mutations are predicted to account for 6% of all IHH cases. TAC3 or TACR3 mutations segregated with IHH in four of nine unrelated consanguineous families.
  • Some genes, including PROK2 and FGFR1, are associated with both anosmic and normosmic IHH. Many cases are predicted to be polygenic, and sex-associated factors contribute to the phenotype, reinforced by a 5:1 male predominance.
  • Reversal of hypogonadism after hormone treatment has been reported with KAL1, FGFR1, and GNRHR mutations, suggesting that partial loss of function may be compensated in some cases.

Methods

  • Narrative review based on literature searches of Google Scholar and MEDLINE from 1990 to 2009 using keywords including “IHH,” “hypogonadism,” “Kallmann syndrome,” “anosmia,” “FGFR1,” “KAL1,” “GnRH,” “GPR54,” “kisspeptin,” “PROK2,” “PROKR2,” “leptin,” and “prohormone convertase.”
  • No primary sample or new experimental data; the paper synthesizes human genetic findings with animal and in vitro functional studies, categorizing genes by roles in GnRH neuronal development/migration, GnRH secretion, or GnRH action.

Limitations

  • The paper states that the genetic causes of the vast majority of IHH cases remain unknown and that the individual and/or combined roles of many recently identified genes are not yet completely understood.
  • Evident from the text: this is a narrative review without a systematic quantitative synthesis; prevalence estimates are drawn from cited studies and vary widely (for example, GNRHR mutations in 3.5–16% of sporadic versus up to 40% of familial normosmic IHH), and several mechanisms are inferred from animal or in vitro models.

Model-written summary. Check it against the paper before relying on it.

Integrity signals

Registry

Crossref · 10.1038/nrendo.2009.177

Cites

75 of 75 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Verification

Claims the paper makes

0 of 109 cited sources checked · 0 supported · 0 flagged

Show all 76 claims

  • It may state two separate claims as one. 38
  • Probably not a substantial claim. 1
39 of 39
  • The paper relies on this without support.

    The major underlying cause of IHH is failure to activate pulsatile secretion of gonadotropin-releasing hormone (GnRH) during puberty.

    “The major underlying cause of IHH is failure to activate pulsatile secretion of gonadotropin-releasing hormone (GnRH) during puberty, a developmental stage characterized by a substantial increase in the frequency and amplitude of pulses of this hormone.”
  • The paper relies on this without support.

    Impaired migration of GnRH and olfactory neurons is the underlying cause of Kallmann syndrome.

    “Impaired migration of GnRH and olfactory neurons is the underlying cause of Kallmann syndrome (IHH associated with anosmia).”
2 of 2

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

Each contradiction between two passages listed here was confirmed by an independent check.

  • LEP and LEPR citations are reversed

    Minor

    The text cites reference 58 for LEP and 59 for LEPR, but the reference list identifies 58 as a leptin receptor study and 59 as a leptin mutation study.

  • Anosmin 1 is described as both 680 and 610 amino acids long

    Minor

    The KAL1 section states that anosmin 1 is 680 amino acids long, but later calculates the extent of a truncation using a 610-amino-acid protein. A stop at amino acid 85 would leave approximately 595, not 525, amino acids missing from a 680-amino-acid protein.

2 of 2

Citations

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Metadata

Authors
Bianco, S. D. C., & Kaiser, U. B.
Affiliations
  • University of Miami (US)
  • Brigham and Women's Hospital (US)
Corresponding author
Kaiser, Ursula B.
Venue
Nature Reviews Endocrinology
Published
2009-08-25
Volume
5
Issue
10
Pages
569-576
ISSN
  • 1759-5029 (ISSN-L)
  • 1759-5037
OpenAlex
W2051108558
Cited by
336
References
77
Citations by year
2026: 7 · 2025: 16 · 2024: 18 · 2023: 20 · 2022: 31 · 2021: 22 · 2020: 16 · 2019: 22 · 2018: 17 · 2017: 21 · 2016: 14 · 2015: 20 · 2014: 22 · 2013: 24 · 2012: 21
FWCI
3.11
Type
journal article
Language
en
Open access
Locations
  • Nature Reviews Endocrinology (publishedVersion)
  • PubMed (publishedVersion)
  • PubMed Central (acceptedVersion)
Funders
  • National Institutes of Health
  • Eunice Kennedy Shriver National Institute of Child Health and Human Development (R01HD019938, K12HD051959, HD028138, R01 HD051959, R21HD059015, U54HD028138)
Topics
  • Health Sciences › Medicine › Reproductive Medicine › Hypothalamic control of reproductive hormones
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Pituitary Gland Disorders and Treatments
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Sexual Differentiation and Disorders
Keywords
idiopathic hypogonadotropic hypogonadism, Kallmann syndrome, anosmia, KAL1, FGFR1, prokineticin 2, PROKR2, GnRH receptor, KISS1R, TAC3, TACR3, nasal placode, hypothalamus, genetic mutations, molecular mechanisms
MeSH terms
Olfaction Disorders, Gastrointestinal Hormones, Humans, Hypogonadism, Nerve Tissue Proteins, Neuropeptides, Extracellular Matrix Proteins, Receptors, Peptide, Receptors, G-Protein-Coupled, Receptor, Fibroblast Growth Factor, Type 1

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