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Du X, Jia Q, Wu S, Wang B, Guan Y. Successful live birth in women with partial 17α-hydroxylase deficiency: report of two cases. Reprod Biomed Online 2024; 49:103855. [PMID: 38776749 DOI: 10.1016/j.rbmo.2024.103855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Revised: 01/02/2024] [Accepted: 01/25/2024] [Indexed: 05/25/2024]
Abstract
RESEARCH QUESTION Can women with partial 17α-hydroxylase deficiency (17-OHD) conceive naturally with adequate hormonal control and endometrial preparation? DESIGN This report presents two cases of women with partial 17-OHD who achieved successful pregnancies. The first case involved a 27-year-old Chinese woman with recurrent cysts and infertility, and the second case involved a 32-year-old Chinese woman with a complex disorder requiring IVF. Both cases were treated with oral prednisone to control hormone concentrations and underwent endometrial preparation. RESULTS In the first case, the patient resumed spontaneous ovulation, conceived naturally, and gave birth to a healthy baby. In the second case, after cryopreserving embryos due to a thin endometrium, the patient underwent frozen embryo transfer and achieved a singleton pregnancy. CONCLUSION This study suggests that women with partial 17-OHD can conceive naturally with appropriate hormonal management and endometrial preparation. These findings provide valuable insights into the reproductive potential of women with this disorder, and highlight the importance of further research in this area.
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Affiliation(s)
- Xiaofang Du
- Reproductive Medicine Centre, The Third Affiliated Hospital of Zhengzhou University, No. 7 Kangfu Road, Zhengzhou 450000, China
| | - Qi Jia
- Reproductive Medicine Centre, The Third Affiliated Hospital of Zhengzhou University, No. 7 Kangfu Road, Zhengzhou 450000, China
| | - Sheling Wu
- Reproductive Medicine Centre, The Third Affiliated Hospital of Zhengzhou University, No. 7 Kangfu Road, Zhengzhou 450000, China
| | - Bijun Wang
- Reproductive Medicine Centre, The Third Affiliated Hospital of Zhengzhou University, No. 7 Kangfu Road, Zhengzhou 450000, China
| | - Yichun Guan
- Reproductive Medicine Centre, The Third Affiliated Hospital of Zhengzhou University, No. 7 Kangfu Road, Zhengzhou 450000, China.
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2
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Siklar Z, Camtosun E, Bolu S, Yildiz M, Akinci A, Bas F, Dündar İ, Bestas A, Ünal E, Kocaay P, Guran T, Buyukyilmaz G, Ugurlu AK, Tosun BG, Turan I, Kurnaz E, Yuksel B, Turkkahraman D, Cayir A, Celmeli G, Gonc EN, Eklioğlu BS, Cetinkaya S, Yilmaz SK, Atabek ME, Buyukinan M, Arslan E, Mengen E, Cakir EDP, Karaoglan M, Hatipoglu N, Orbak Z, Ucar A, Akyurek N, Akbas ED, Isik E, Kaygusuz SB, Sutcu ZK, Seymen G, Berberoglu M. 17α Hydroxylase/17,20 lyase deficiency: clinical features and genetic insights from a large Turkey cohort. Endocrine 2024:10.1007/s12020-024-03962-6. [PMID: 39020240 DOI: 10.1007/s12020-024-03962-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2024] [Accepted: 07/08/2024] [Indexed: 07/19/2024]
Abstract
PURPOSE 17α Hydroxylase/17,20 lyase deficiency (17OHD) is a rare form of congenital adrenal hyperplasia, typically diagnosed in late adolescence with symptoms of pubertal delay and hypertension. This study aimed to determine the clinical and laboratory characteristics of 17OHD cases and gather data on disease management. METHODS Data from 97 nationwide cases were analyzed using the CEDD-NET web system. Diagnostic, follow-up findings, and final heights of patients were evaluated. RESULTS Mean age at admission was 13.54 ± 4.71 years, with delayed puberty as the most common complaint. Hypertension was detected in 65% at presentation; hypokalemia was present in 34%. Genetic analysis revealed Exon 1-6 homozygous deletion as the most frequent mutation, identified in 42 cases. Hydrocortisone replacement was universal; pubertal replacement was administered to 66 cases. Antihypertensive treatment was required in 57 (90%) patients. Thirty-seven cases reached final height, with an average SD of 0.015 in 46,XX and -1.43 in 46,XY. Thelarche and pubarche did not develop properly in some cases despite estradiol treatment. CONCLUSION This study represents the largest cohort of pediatric cases of 17-hydroxylase deficiency (17OHD) documented in the literature. Hypertension and hypokalemia can serve as guiding indicators for early diagnosis.The final height is typically considered to be normal. The relationship between genotype and phenotype remains elusive. The initial genetic test for exon 1-6 deletions may be MLPA in our region.
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Affiliation(s)
- Zeynep Siklar
- Ankara University Faculty of Medicine, Department of Pediatric Endocrinology, Ankara, Türkiye
| | - Emine Camtosun
- Inonu University Faculty of Medicine, Department of Pediatric Endocrinology and Diabetes, Malatya, Türkiye
| | - Semih Bolu
- Bolu Abant Izzet Baysal University Faculty of Medicine, Department of Pediatric Endocrinology, Bolu, Türkiye
| | - Melek Yildiz
- Istanbul University Faculty of Medicine, Department of Pediatric Endocrinology, Istanbul, Türkiye
| | - Aysehan Akinci
- Inonu University Faculty of Medicine, Department of Pediatric Endocrinology and Diabetes, Malatya, Türkiye
| | - Firdevs Bas
- Istanbul University Faculty of Medicine, Department of Pediatric Endocrinology, Istanbul, Türkiye
| | - İsmail Dündar
- Inonu University Faculty of Medicine, Department of Pediatric Endocrinology and Diabetes, Malatya, Türkiye
| | - Asli Bestas
- Dicle University Faculty of Medicine, Department of Pediatric Endocrinology, Diyarbakır, Türkiye
| | - Edip Ünal
- Dicle University Faculty of Medicine, Department of Pediatric Endocrinology, Diyarbakır, Türkiye
| | - Pinar Kocaay
- Ankara Bilkent City Hospital, Clinic of Pediatric Endocrinology, Ankara, Türkiye
| | - Tulay Guran
- Marmara University Faculty of Medicine, Department of Pediatric Endocrinology and Diabetes, Istanbul, Türkiye
| | - Gonul Buyukyilmaz
- Ankara Bilkent City Hospital, Clinic of Pediatric Endocrinology, Ankara, Türkiye
| | - Aylin Kilinc Ugurlu
- Ankara Bilkent City Hospital, Clinic of Pediatric Endocrinology, Ankara, Türkiye.
| | - Buşra Gurpinar Tosun
- Marmara University Faculty of Medicine, Department of Pediatric Endocrinology and Diabetes, Istanbul, Türkiye
| | - Ihsan Turan
- Cukurova University Faculty of Medicine, Department of Pediatric Endocrinology, Adana, Türkiye
| | - Erdal Kurnaz
- Ankara Etlik City Hospital, Clinic of Pediatric Endocrinology, Ankara, Türkiye
| | - Bilgin Yuksel
- Cukurova University Faculty of Medicine, Department of Pediatric Endocrinology, Adana, Türkiye
| | - Doga Turkkahraman
- University of Health Sciences, Antalya Training and Resarch Hospital, Clinic of Pediatric Endocrinology, Antalya, Türkiye
| | - Atilla Cayir
- University of Health Sciences, Erzurum Training and Resarch Hospital, Clinic of Pediatric Endocrinology and Diabetes, Erzurum, Turkey
| | - Gamze Celmeli
- University of Health Sciences, Antalya Training and Resarch Hospital, Clinic of Pediatric Endocrinology, Antalya, Türkiye
| | - E Nazli Gonc
- Hacettepe University Faculty of Medicine, İhsan Doğramacı Children's Hospital, Department of Pediatric Endocrinology, Ankara, Türkiye
| | - Beray Selver Eklioğlu
- Necmettin Erbakan University Faculty of Medicine, Department of Pediatric Endocrinology, Konya, Türkiye
| | - Semra Cetinkaya
- University of Health Sciences, Dr Sami Ulus Child Health and Diseases Training and Research Hospital, Clinic of Pediatric Endocrinology, Ankara, Türkiye
| | - Seniha Kiremitci Yilmaz
- University of Health Sciences, Haseki Training and Research Hospital, Clinic of Pediatric Endocrinology, Istanbul, Türkiye
| | - Mehmet Emre Atabek
- Necmettin Erbakan University Faculty of Medicine, Department of Pediatric Endocrinology, Konya, Türkiye
| | - Muammer Buyukinan
- Selcuk University Faculty of Medicine, Department of Pediatric Endocrinology, Konya, Türkiye
| | - Emrullah Arslan
- Ege University Faculty of Medicine, Department of Pediatric Endocrinology and Diabetes, Izmir, Türkiye
| | - Eda Mengen
- Ankara Training and Research Hospital, Ankara, Türkiye
| | - Esra Deniz Papatya Cakir
- University of Health Sciences, Bakirkoy Dr. Sadi Konuk Training and Resarch Hospital, Clinic of Pediatric Endocrinology, Istanbul, Türkiye
| | - Murat Karaoglan
- Gaziantep University Faculty of Medicine,, Department of Pediatric Endocrinology, Gaziantep, Türkiye
| | - Nihal Hatipoglu
- Erciyes University Faculty of Medicine, Department of Pediatric Endocrinology, Kayseri, Türkiye
| | - Zerrin Orbak
- Ataturk University Faculty of Medicine, Department of Pediatric Endocrinology and Diabetes, Erzurum, Türkiye
| | - Ahmet Ucar
- University of Health Sciences, Şişli Hamidiye Etfal Training and Resarch Hospital, Clinic of Pediatric Endocrinology, İstanbul, Türkiye
| | - Nesibe Akyurek
- Baskent University Faculty of Medicine, Department of Pediatric Endocrinology, Konya, Türkiye
| | | | - Emregül Isik
- Gaziantep Children's Hospital, Gaziantep, Türkiye
| | | | - Zumrut Kocabey Sutcu
- Basaksehir Cam and Sakura City Hospital, Clinic of Pediatric Endocrinology, İstanbul, Türkiye
| | - Gulcan Seymen
- University of Health Sciences, Umraniye Training and Research Hospital, Clinic of Pediatric Endocrinology, İstanbul, Türkiye
| | - Merih Berberoglu
- Ankara University Faculty of Medicine, Department of Pediatric Endocrinology, Ankara, Türkiye
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Çömlek FÖ, Gümüş U. An unusual case of 17-hydroxylase deficiency presenting with short stature. Arch Pediatr 2024:S0929-693X(24)00089-7. [PMID: 39003161 DOI: 10.1016/j.arcped.2024.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 03/18/2024] [Accepted: 03/18/2024] [Indexed: 07/15/2024]
Abstract
17α-Hydroxylase and 17,20-lyase are enzymes encoded by the CYP17A1 gene and are necessary for the production of cortisol and sex steroids. Females with 17α-hydroxylase deficiency usually present with primary amenorrhea and delayed puberty accompanied by hypertension and electrolyte imbalance. Here, we report the case of a 14-year-old female patient who presented with severe short stature and delayed puberty without any complaint suggestive of 17-hydroxylase enzyme deficiency. Laboratory test results showed low cortisol and dehydroepiandrosterone sulfate (DHEA-S) along with high luteinizing hormone (LH) and follicle-stimulating hormone (FSH). Turner syndrome was excluded after genetic analysis showed a 46,XX karyotype, and 17α-hydroxylase deficiency was diagnosed by detecting a c.1319G>A (p.Arg440His) variation/alternation in the patient's CYP17A1 gene.
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Affiliation(s)
| | - Uğur Gümüş
- Medical Genetics, Dr. Ersin Arslan Training and Research Hospital, Turkey
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4
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Zhang Y, Yuan Y. Genetic diagnosis and clinical analysis of 17α-hydroxylase/17, 20-lyase deficiency combined with type 2 diabetes mellitus: A case report. Medicine (Baltimore) 2023; 102:e36727. [PMID: 38206738 PMCID: PMC10754554 DOI: 10.1097/md.0000000000036727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Accepted: 11/29/2023] [Indexed: 01/13/2024] Open
Abstract
RATIONALE 17α-Hydroxylase/17, 20-lyase deficiency (17OHD) is a recessively inherited autosomal disease caused by CYP17A1 gene mutations. It is characterized by failure to synthesize cortisol, adrenal androgens and gonadal steroids. However, it is rare in clinic combining with type 2 diabetes mellitus (T2DM). PATIENT CONCERNS A 21-year-old woman was transferred to an endocrinology clinic because of paroxysmal paralysis. In addition, she presented with hypertension, primary amenorrhea and lack of pubertal development. Blood evaluation revealed hypokalemia, and a low cortisol level with an increased adrenocorticotropic hormone concentration. The renin activity and testosterone and estrogen levels were suppressed, and the gonadotropin levels were high. CT scan showed bilateral adrenal hyperplasia. Besides, this patient had hyperglycemia, hyperinsulinism and negative diabetes type 1 related antibodies. A homozygous mutation c. 985 to 987delinsAA in exon 6 was found in the patient which caused the missense mutation (p.Y329fs). DIAGNOSES 17α-hydroxylase/17, 20-lyase deficiency combined with T2DM was considered. INTERVENTIONS The patient received dexamethasone, estradiol valerate, metformin, amlodipine besylate and D3 calcium carbonate tablets. The doses of dexamethasone was changed according to her blood potassium levels. OUTCOMES After treatment, the blood pressure, blood potassium and blood glucose returned to normal range. Besides, she had restored her menstrual cycle. LESSONS For patients with hypertension, hypokalemia and lack of pubertal development, the possibility of 17OHD should be considered. The subsequent treatment would be challenging in patients with combined 17OHD and T2DM, considering the potential contribution of glucocorticoids to diabetic balance and osteoporosis.
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Affiliation(s)
- Yumin Zhang
- Department of Geriatric Endocrinology, Jiangsu Province Hospital and Nanjing Medical University First Affiliated Hospital, Nanjing, Jiangsu Province, China
- Department of Endocrinology, Zhongda Hospital, Southeast University, Nanjing, Jiangsu Province, China
| | - Yuexing Yuan
- Department of Endocrinology, Zhongda Hospital, Southeast University, Nanjing, Jiangsu Province, China
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Tian Y, Hou L, Xiang S, Tian X, Xu J. Congenital adrenal hyperplasia disorder due to 17 α-hydroxylase deficiency: a case report. Gynecol Endocrinol 2023; 39:2250001. [PMID: 37683689 DOI: 10.1080/09513590.2023.2250001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 06/06/2023] [Accepted: 08/14/2023] [Indexed: 09/10/2023] Open
Abstract
Congenital adrenal hyperplasia (CAH) is an autosomal recessive disorder with a related enzyme deficiency involved in the adrenal corticosteroid synthesis pathway due to genetic mutations. 17α-hydroxylase deficiency(17α-OHD) is a rare form of CAH. Herein, we reported clinical data on diagnosis and treatment regimens for a 17α-hydroxylase-deficient patient. A 24-year-old female patient was admitted to the hospital with limb numbness for 7 days and sudden limb weakness. Full laboratory and radio-imaging investigations showed hypokalemia and abdominal occupation. Abnormal rhythm of cortisol(Cor) and adrenocorticotrophic hormone (ACTH)was observed. The diagnosis was confirmed by molecular mutation detection, which showed a homozygous mutation of c.987del in the 17-hydroxylase/17,20-lyase deficiency (17OHD) lease-related CYP17A1 from both biological parents. The patient was treated with prednisone acetate and estradiol valerate. After one year of treatment with predisoone acetate and estradiol valerate, the patient had normal menstruation, increased blood potassium, estradiol and 24h-UFC, and decreased ACTH level. There is no significant change in large adrenal hyperplasia lesions although sexual characteristics and menstrual cycles have recovered. Through this case and literature review, it can be concluded that CAH with 17α-OHD can be diagnosed according to the genetic detection.
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Affiliation(s)
- Yunling Tian
- Department of Endocrinology and Metabolic, The First Hospital of Lanzhou University, Lanzhou, Gansu, P.R.China
| | - Lijie Hou
- Department of Endocrinology and Metabolic, The First Hospital of Lanzhou University, Lanzhou, Gansu, P.R.China
| | - Shulan Xiang
- Department of General Family Medicine, The First Hospital of Lanzhou University, Lanzhou, Gansu, P.R.China
| | - Xuguang Tian
- Lintao Country People's Hospital, Lintao, Dingxi, Gansu, P.R.China
| | - Jinhui Xu
- Department of Respiratory medicine, The First Hospital of Lanzhou University, Lanzhou, Gansu, P.R.China
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Yao JT, Xu MZ, Zhang YR, Wang BR, Li MR, Gao L. Refractory hypokalemia with sexual dysplasia and infertility caused by 17α-hydroxylase deficiency and triple X syndrome: A case report. Open Life Sci 2023; 18:20220548. [PMID: 36820210 PMCID: PMC9938537 DOI: 10.1515/biol-2022-0548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Revised: 11/24/2022] [Accepted: 12/14/2022] [Indexed: 02/15/2023] Open
Abstract
The present study reports a patient case with a 17α-hydroxylase deficiency accompanied by triple X syndrome. A 17α-hydroxylase deficiency leads to a very low 17α-hydroxylated steroid synthesis as well as a non-feedback increase in the adrenocorticotropic hormone level. Meanwhile, the progesterone level increases the 17α-hydroxyprogesterone level and decreases the dehydroepiandrosterone sulfate level. The patient is characterized by intractable hypokalemia, high urinary potassium, hyperaldosteronemia, hyporeninemia, hypocortisolemia, hypertension, gonadal and secondary sexual dysplasia, a decreased estrogen level, primary amenorrhea, and infertility. The imaging findings indicate a presence of multiple bilateral adrenal gland adenomas, and the sequencing indicates a missense CYP17A1-E7 gene pathogenic variant. The karyotype is a 47, XXX [3]/46, XX [47] low-level chimeric karyotype. The patient's parents are cousins. To our knowledge, this patient is the first case diagnosed with congenital adrenal hyperplasia caused by hydroxylase deficiency and triple X syndrome. The uniqueness of this case is that this patient has two very rare genetic diseases, probably due to the marriage of close relatives.
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Affiliation(s)
- Jun-Teng Yao
- Department of Endocrinology, Jinjiang Municipal Hospital, No. 16 of Luoshan section, Jinguang Road, Jinjiang 362200, China
| | - Ming-Zhi Xu
- Department of Endocrinology, Shulan Hospital, Hangzhou310000, China
| | - Yu-Ren Zhang
- Department of Endocrinology, Jinjiang Municipal Hospital, Jinjiang 362200, China
| | - Bai-Rong Wang
- Department of Endocrinology, Jinjiang Municipal Hospital, Jinjiang 362200, China
| | - Mei-Rong Li
- Department of Endocrinology, Jinjiang Municipal Hospital, Jinjiang 362200, China
| | - Lu Gao
- Department of Endocrinology, Jinjiang Municipal Hospital, Jinjiang 362200, China
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Ishinoda Y, Uto A, Yamada Y, Okazaki M, Asada H, Wakamatsu S, Kurihara I, Shibata H, Ishii T, Hasegawa T, Kumagai H, Kasuga A. An elderly patient with 17α-hydroxylase deficiency misdiagnosed as primary aldosteronism: a case report. BMC Endocr Disord 2022; 22:300. [PMID: 36461073 PMCID: PMC9717510 DOI: 10.1186/s12902-022-01216-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Accepted: 11/14/2022] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND 17α-hydroxylase deficiency (17OHD) is a rare autosomal recessive disorder. Aldosterone levels are usually low in patients with 17OHD. However, among the approximately 150 cases of 17OHD reported to date, aldosterone levels were not low in all cases. Therefore, some 17OHD cases may have been misdiagnosed as primary aldosteronism (PA) cases. Often before puberty, 17OHD is diagnosed because of abnormal genital morphology and menstrual irregularities. However, we report a very rare case of 17OHD in an elderly patient with a high aldosterone/renin ratio (ARR) similar to that in PA. CASE PRESENTATION A 63-year-old Japanese woman was transferred to our medical facility for the evaluation of bilateral adrenal hypertrophy, which was incidentally discovered during an abdominal examination after cholecystectomy. The patient had hypokalemia and a high aldosterone/renin ratio. Her medical history included hypertension and right intracerebral capsular hemorrhage at the age of 30 years. Additional testing revealed low cortisol, high adrenocorticotropic hormone, and low testosterone and dehydroepiandrosterone sulfate, indicating congenital adrenal hyperplasia. Genetic analysis revealed a mutation in the CYP17A1 gene and a karyotype of 46, XY; hence, she was diagnosed with 17OHD. CONCLUSION 17OHD can resemble PA. The combination of a high ARR and low cortisol level should trigger the consideration of 17OHD.
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Affiliation(s)
- Yuki Ishinoda
- Department of Endocrinology, National Defense Medical College, 3-2 Namiki, 359-8513, Tokorozawa-shi, Saitama, Japan.
| | - Asuka Uto
- Department of Endocrinology, National Defense Medical College, 3-2 Namiki, 359-8513, Tokorozawa-shi, Saitama, Japan
| | - Yoshifumi Yamada
- Department of Endocrinology, National Defense Medical College, 3-2 Namiki, 359-8513, Tokorozawa-shi, Saitama, Japan
| | - Maki Okazaki
- Department of Endocrinology, National Defense Medical College, 3-2 Namiki, 359-8513, Tokorozawa-shi, Saitama, Japan
| | - Hidetomo Asada
- Department of Endocrinology, National Defense Medical College, 3-2 Namiki, 359-8513, Tokorozawa-shi, Saitama, Japan
| | - Seina Wakamatsu
- Department of Endocrinology, National Defense Medical College, 3-2 Namiki, 359-8513, Tokorozawa-shi, Saitama, Japan
| | - Isao Kurihara
- Department of Endocrinology, National Defense Medical College, 3-2 Namiki, 359-8513, Tokorozawa-shi, Saitama, Japan
| | - Hironori Shibata
- Department of Pediatrics, Keio University School of Medicine, Tokyo, Japan
| | - Tomohiro Ishii
- Department of Pediatrics, Keio University School of Medicine, Tokyo, Japan
| | - Tomonobu Hasegawa
- Department of Pediatrics, Keio University School of Medicine, Tokyo, Japan
| | - Hiroo Kumagai
- Department of Endocrinology, National Defense Medical College, 3-2 Namiki, 359-8513, Tokorozawa-shi, Saitama, Japan
| | - Akira Kasuga
- Department of Endocrinology, National Defense Medical College, 3-2 Namiki, 359-8513, Tokorozawa-shi, Saitama, Japan
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Zhao Z, Lu L, Wang O, Wu X, Sun B, Zhang W, Wang X, Mao J, Chen S, Tong A, Nie M. High incidence of hypertension-mediated organ damage in a series of Chinese patients with 17α-hydroxylase deficiency. Endocrine 2022; 76:151-161. [PMID: 35032013 DOI: 10.1007/s12020-021-02966-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Accepted: 12/12/2021] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To analyze the prevalence of hypertension-mediated organ damage (HMOD) and its relationship with enzyme activity of mutant CYP17A1 and other risk factors in patients with 17α-hydroxylase/17,20-lyase deficiency (17-OHD). METHODS A total of 68 patients with 17-OHD were recruited in the Peking Union Medical College Hospital from 2003 to 2021. The incidence of hypertension and HMOD was respectively analyzed. CYP17A1 sequencing was performed and the enzyme activity of mutant CYP17A1 was determined by analyzing the characteristics of mutation itself and the functional data reported previously. A logistic regression model was employed to analyze the factors related to HMOD and the specific damaged organs in 17-OHD patients. RESULT(S) Sixty-five patients (95.6%) exhibited hypertension, 32 of whom were diagnosed with HMOD. c.985_987delTACinsAA (p.Y329KfsX418) (53.8%) and c.1459_1467del (p. del D487_F489) (11.4%) were the top two mutations, and no correlation was found between enzyme activity of mutant CYP17A1 and HMOD. The risk of HMOD increased by 32% for each additional year of hypertension duration, 10.2-fold for each one-grade increase in hypertension level, 2.3-fold for each grade of exacerbation of hypokalemia. CONCLUSION Patients with 17-OHD experience a high incidence of HMOD. There was no correlation between the HMOD occurrence and enzyme activity of mutant CYP17A1. Longer duration of hypertension, more severe hypertension, and hypokalemia were independent risk factors for the occurrence of HMOD in patients with 17-OHD.
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Affiliation(s)
- Zhiyuan Zhao
- Department of Endocrinology, NHC Key laboratory of Endocrinology (Peking Union Medical College Hospital), State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, 100730, China
| | - Lin Lu
- Department of Endocrinology, NHC Key laboratory of Endocrinology (Peking Union Medical College Hospital), State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, 100730, China
| | - Ou Wang
- Department of Endocrinology, NHC Key laboratory of Endocrinology (Peking Union Medical College Hospital), State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, 100730, China
| | - Xueyan Wu
- Department of Endocrinology, NHC Key laboratory of Endocrinology (Peking Union Medical College Hospital), State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, 100730, China
| | - Bang Sun
- Department of Endocrinology, NHC Key laboratory of Endocrinology (Peking Union Medical College Hospital), State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, 100730, China
| | - Wei Zhang
- Department of Endocrinology, NHC Key laboratory of Endocrinology (Peking Union Medical College Hospital), State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, 100730, China
| | - Xi Wang
- Department of Endocrinology, NHC Key laboratory of Endocrinology (Peking Union Medical College Hospital), State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, 100730, China
| | - Jiangfeng Mao
- Department of Endocrinology, NHC Key laboratory of Endocrinology (Peking Union Medical College Hospital), State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, 100730, China
| | - Shi Chen
- Department of Endocrinology, NHC Key laboratory of Endocrinology (Peking Union Medical College Hospital), State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, 100730, China
| | - Anli Tong
- Department of Endocrinology, NHC Key laboratory of Endocrinology (Peking Union Medical College Hospital), State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, 100730, China
| | - Min Nie
- Department of Endocrinology, NHC Key laboratory of Endocrinology (Peking Union Medical College Hospital), State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, 100730, China.
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9
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Singh H, Kumar R, Mazumder A, Salahuddin, Mazumder R, Abdullah MM. Insights into Interactions of Human Cytochrome P450 17A1: Review. Curr Drug Metab 2022; 23:172-187. [DOI: 10.2174/1389200223666220401093833] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Revised: 01/15/2022] [Accepted: 02/04/2022] [Indexed: 11/22/2022]
Abstract
Abstract:
Cytochrome P450s are a widespread and vast superfamily of hemeprotein monooxygenases that metabolize physiologically essential chemicals necessary for most species' survival, from protists to plants to humans. They catalyze the synthesis of steroid hormones, cholesterol, bile acids, and arachidonate metabolites and the degradation of endogenous compounds such as steroids, fatty acids, and other catabolizing compounds as an energy source and detoxifying xenobiotics such as drugs, procarcinogens, and carcinogens. The human CYP17A1 is one of the cytochrome P450 genes located at the 10q chromosome. The gene expression occurs in the adrenals and gonads, with minor amounts in the brain, placenta, and heart. This P450c17 cytochrome gene is a critical steroidogenesis regulator which performs two distinct activities: 17 alpha-hydroxylase activity (converting pregnenolone to 17-hydroxypregnenolone and progesterone to 17-hydroxyprogesterone, these precursors are further processed to provide glucocorticoids and sex hormones) and 17, 20-lyase activity (which converts 17-hydroxypregnenolone to DHEA). Dozens of mutations within CYP17A1 are found to cause 17-alpha-hydroxylase and 17, 20-lyase deficiency. This condition affects the function of certain hormone-producing glands, resulting in high blood pressure levels (hypertension), abnormal sexual development, and other deficiency diseases. This review highlights the changes in CYP17A1 associated with gene-gene interaction, drug-gene interaction, chemical-gene interaction, and its biochemical reactions; they have some insights to correlate with the fascinating functional characteristics of this human steroidogenic gene. The findings of our theoretical results will be helpful to further the design of specific inhibitors of CYP17A1.
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Affiliation(s)
- Himanshu Singh
- Department of Pharmaceutical Chemistry, Noida Institute of Engineering and Technology (Pharmacy Institute), Greater Noida, India
| | - Rajnish Kumar
- Department of Pharmaceutical Chemistry, Noida Institute of Engineering and Technology (Pharmacy Institute), Greater Noida, India
| | - Avijit Mazumder
- Department of Pharmaceutical Chemistry, Noida Institute of Engineering and Technology (Pharmacy Institute), Greater Noida, India
| | - Salahuddin
- Department of Pharmaceutical Chemistry, Noida Institute of Engineering and Technology (Pharmacy Institute), Greater Noida, India
| | - Rupa Mazumder
- Department of Pharmaceutical Chemistry, Noida Institute of Engineering and Technology (Pharmacy Institute), Greater Noida, India
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Beştaş A, Bolu S, Unal E, Aktar Karakaya A, Eröz R, Tekin M, Haspolat YK. A rare cause of delayed puberty and primary amenorrhea: 17α-hydroxylase enzyme deficiency. Endocrine 2022; 75:927-933. [PMID: 34724156 DOI: 10.1007/s12020-021-02914-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Accepted: 10/13/2021] [Indexed: 12/13/2022]
Abstract
AIM 17α-hydroxylase enzyme deficiency is a rare form of congenital adrenal hyperplasia (CAH) and is caused by mutations in the CYP17A1 gene. The main clinical findings are delayed puberty and primary amenorrhea in girls, and disorders of sex development in boys. It can also cause hypertension and hypokalemia in both genders. In this study, we aimed to present the clinical, laboratory and genetic results of 13 patients from eight different families who were diagnosed with complete 17α-hydroxylase enzyme deficiency. METHODS The age, symptoms, anthropometric measurements, blood pressure, Tanner stages, and hormonal and chromosome analysis results at the time of admission were recorded from the medical records of the patients. Whole gene next-generation sequencing of CYP17A1 gene was performed to detect mutations. Multiplex ligation dependent probe amplification (MLPA) method were used to detect deletions in the seven patients who had no point mutation were detected in the CYP17A1 gene. RESULTS The average age of the patients at the time of admission was 14.8 (range: 12.9-16.6) years. Also at this time, all patients were in adolescence and were raised as females. The karyotypes of eight patients were 46,XY, and of five patients were 46,XX. Ten patients presented with delayed puberty and primary amenorrhea, one patient with delayed puberty and hypertension, and two patients with hypertension and/or hypokalemia. Hypertension and hypokalemia were detected in nine and seven patients, respectively. CONCLUSIONS P450c17 enzyme deficiency should be considered in patients presenting with delayed puberty or primary amenorrhea in the adolescence period and diagnosed with hypergonadotropic hypogonadism, if hypertension and hypokalemia accompany. Early diagnosis prevents the occurrence of important health problems such as hypertension, psychological problems, and gender identity disorders, which affect the majority of these patients.
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Affiliation(s)
- Aslı Beştaş
- Faculty of Medicine, Department of Pediatric Endocrinology, Dicle University, Diyarbakır, Turkey.
| | - Semih Bolu
- Department of Pediatric Endocrinology, Adıyaman Training and Research Hospital, Adıyaman, Turkey
| | - Edip Unal
- Faculty of Medicine, Department of Pediatric Endocrinology, Dicle University, Diyarbakır, Turkey
| | - Amine Aktar Karakaya
- Faculty of Medicine, Department of Pediatric Endocrinology, Dicle University, Diyarbakır, Turkey
| | - Recep Eröz
- Medical Faculty, Department of Medical Genetics, Duzce University, Duzce, Turkey
| | - Mehmet Tekin
- Department of Pediatrics, Adıyaman Training and Research Hospital, Adıyaman, Turkey
| | - Yusuf Kenan Haspolat
- Faculty of Medicine, Department of Pediatric Endocrinology, Dicle University, Diyarbakır, Turkey
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Liao Q, Shen R, Liao M, Ran C, Zhou L, Zhang Y, Peng G, Sun Z, Zheng H, Long M. An Asian case of combined 17α-hydroxylase/17,20-lyase deficiency due to homozygous p.R96Q mutation: A case report and review of the literature. Front Endocrinol (Lausanne) 2022; 13:989447. [PMID: 36339422 PMCID: PMC9627194 DOI: 10.3389/fendo.2022.989447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Accepted: 09/26/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Combined 17α-hydroxylase/17,20-lyase deficiency (17-OHD) is a very rare form of congenital adrenal hyperplasia (CAH) caused by mutations in the CYP17A1 gene. Almost 100 different mutations of the CYP17A1 gene have been reported, including p.R96Q mutation, but no case of p.R96Q mutation has been described in Asian populations. CASE PRESENTATION We describe a 22-year-old female patient of 46,XY karyotype, who presented with pseudohermaphrodism, primary amenorrhea, underdeveloped secondary sexual characteristics, delayed epiphyseal healing, hypertension, and hypokalemia. The diagnosis of 17-OHD was reached by measurement of steroid hormones and abdominal CT scan and confirmed by genetic sequencing, which revealed a homozygous p.R96Q missense mutation in the CYP17A1 gene. The patient received treatment with dexamethasone and estradiol, and 4 months of follow-up showed that both blood pressure and potassium were well controlled. CONCLUSIONS This is the first Asian case of CAH caused by a homozygous p.R96Q missense mutation in the CYP17A1 gene. Herein, we highlight the role of inguinal hernia in the early diagnosis of female 17-OHD and the necessity of removing the ectopic testis.
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Affiliation(s)
- Qian Liao
- Department of Endocrinology, Translational Research Key Laboratory for Diabetes, The Second Affiliated Hospital, Xinqiao Hospital, Army Medical University, Chongqing, China
| | - Rufei Shen
- Department of Endocrinology, Translational Research Key Laboratory for Diabetes, The Second Affiliated Hospital, Xinqiao Hospital, Army Medical University, Chongqing, China
| | - Mingyu Liao
- Department of Endocrinology, Translational Research Key Laboratory for Diabetes, The Second Affiliated Hospital, Xinqiao Hospital, Army Medical University, Chongqing, China
| | - Chenxi Ran
- Department of Endocrinology, Translational Research Key Laboratory for Diabetes, The Second Affiliated Hospital, Xinqiao Hospital, Army Medical University, Chongqing, China
| | - Ling Zhou
- Department of Endocrinology, Translational Research Key Laboratory for Diabetes, The Second Affiliated Hospital, Xinqiao Hospital, Army Medical University, Chongqing, China
| | - Yuling Zhang
- Department of Endocrinology, Translational Research Key Laboratory for Diabetes, The Second Affiliated Hospital, Xinqiao Hospital, Army Medical University, Chongqing, China
| | - Guiliang Peng
- Department of Endocrinology, Translational Research Key Laboratory for Diabetes, The Second Affiliated Hospital, Xinqiao Hospital, Army Medical University, Chongqing, China
| | - Zheng Sun
- Department of Medicine, Division of Diabetes, Endocrinology and Metabolism, Baylor College of Medicine, Houston, TX, United States
- Department of Molecular and Cellular Biology, Baylor College of Medicine, Houston, TX, United States
| | - Hongting Zheng
- Department of Endocrinology, Translational Research Key Laboratory for Diabetes, The Second Affiliated Hospital, Xinqiao Hospital, Army Medical University, Chongqing, China
- *Correspondence: Min Long, ; Hongting Zheng,
| | - Min Long
- Department of Endocrinology, Translational Research Key Laboratory for Diabetes, The Second Affiliated Hospital, Xinqiao Hospital, Army Medical University, Chongqing, China
- *Correspondence: Min Long, ; Hongting Zheng,
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Li J, Zhang Q, Chen J, Fu X, Yang J, Liu L. Case report: 17α- hydroxylase deficiency due to a hotspot variant and a novel compound heterozygous variant in the CYP17 A1 gene of five Chinese patients. Front Pediatr 2022; 10:935191. [PMID: 36210947 PMCID: PMC9532611 DOI: 10.3389/fped.2022.935191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Accepted: 08/31/2022] [Indexed: 11/28/2022] Open
Abstract
17α-Hydroxylase deficiency (17OHD) is a rare form of congenital adrenal hyperplasia caused by mutations in the CYP17A1 gene. It is characterized by impaired adrenal and gonad steroid biosynthesis. Affected patients present with hypertension, hypokalemia, and disorders of sexual development. Here, we describe the genotypes and phenotypes of five patients from three families with this rare disease. Most patients had the hotspot variant, c.985_987delTACinsAA, in CYP17A1, which may be caused by a founder effect. However, the patients in our study were younger than the typical age of onset of 17OHD, and there was a pair of twins with the karyotypes 46, XX and 46, XY, but they both had a female phenotype. Meanwhile, we identified a novel compound heterozygous variant, c.1243+6T>G (p.Y329fs/splicing) in the CYP17A1 gene.
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Affiliation(s)
- Jinying Li
- Department of Endocrinology, Genetics and Metabolism, Children's Hospital of Hebei Province, Shijiazhuang, China
| | - Qiang Zhang
- Department of Endocrinology, Genetics and Metabolism, Children's Hospital of Hebei Province, Shijiazhuang, China
| | - Jing Chen
- Department of Endocrinology, Genetics and Metabolism, Children's Hospital of Hebei Province, Shijiazhuang, China
| | - Xingjiao Fu
- Department of Endocrinology, Genetics and Metabolism, Children's Hospital of Hebei Province, Shijiazhuang, China
| | - Jingpin Yang
- Department of Endocrinology, Genetics and Metabolism, Children's Hospital of Hebei Province, Shijiazhuang, China
| | - Lijun Liu
- Department of Endocrinology, Genetics and Metabolism, Children's Hospital of Hebei Province, Shijiazhuang, China
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13
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Yin M, Yang J, Tian Q, Zhang X. Ovarian gonadoblastoma with dysgerminoma in a girl with 46,XX karyotype 17a-hydroxylase/17, 20-lyase deficiency: A case report and literature review. Front Endocrinol (Lausanne) 2022; 13:989695. [PMID: 36589847 PMCID: PMC9797587 DOI: 10.3389/fendo.2022.989695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Accepted: 11/30/2022] [Indexed: 12/23/2022] Open
Abstract
17α-hydroxylase/17,20-lyase deficiency (17-OHD), caused by mutations in the gene of the cytochrome P450 family 17 subfamily A member 1 (CYP17A1), is a rare type of congenital adrenal hyperplasia (CAH), usually characterized by cortisol and sex steroid deficiency combined with excessive mineralocorticoid. Gonadoblastoma is a relatively rare ovarian tumor that is frequently seen among patients with 46,XY gonadal dysgenesis. Rarely have they been reported in female patients with normal 46,XX karyotype. Here, we report an interesting case of an 11-year-old Chinese girl who presented acute abdominal pain that was later attributed to tumor rupture of right ovarian gonadoblastoma with dysgerminoma. Further evaluations revealed hypertension and hypokalemia. Hormonal findings showed increased progesterone, hypergonadotropic hypogonadism, and low cortisol levels. Her chromosome karyotype was 46,XX without Y chromosome material detected. Genetic analysis revealed that the patient had a homozygous pathogenic variant c.985_987delTACinsAA (p.Y329Kfs*90) in exon 6 of the CYP17A1 gene and that her parents were all heterozygous carriers of this pathogenic variant. Due to the variable clinical manifestations of 17-OHD, meticulous assessment including genetic analysis is necessary. Further study is warranted to unravel the mechanism of gonadoblastoma in a patient with normal karyotypes.
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Yoo HW. Diverse etiologies, diagnostic approach, and management of primary adrenal insufficiency in pediatric age. Ann Pediatr Endocrinol Metab 2021; 26:149-157. [PMID: 34610702 PMCID: PMC8505038 DOI: 10.6065/apem.2142150.075] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Accepted: 08/11/2021] [Indexed: 12/02/2022] Open
Abstract
Primary adrenal insufficiency (PAI) in pediatric age is a rare, but potentially fatal condition caused by diverse etiologies including biochemical defects of steroid biosynthesis, developmental abnormalities of the adrenal gland, or reduced responsiveness to adrenocorticotropic hormone. Compared to adult PAI, pediatric PAI is more often the result of genetic (monogenic, syndromic disorders) than acquired conditions. During the past decade, rare monogenic disorders associated with PAI have helped unravel the underlying novel molecular genetic mechanism. The diagnosis of adrenal insufficiency in children and young infancy is often challenging, usually based on clinical suspicion and endocrine laboratory findings. Pediatric endocrinologists sometimes encounter therapeutic difficulty in finding the balance between undertreatment and overtreatment, determining how to optimize the dose over the patient's lifetime, and maximizing mimicry of normal cortisol secretion with glucocorticoid replacement therapy.
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Affiliation(s)
- Han-Wook Yoo
- Department of Pediatrics, Asan Medical Center Children’s Hospital, University of Ulsan College of Medicine, Seoul, Korea,Address for correspondence: Han-Wook Yoo Department of Pediatrics, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympicro 43-gil, Songpa-gu, Seoul 05505, Korea
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15
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Habib A, Shojazadeh A, Molayemat M, Jafari Khamirani H, Zoghi S, Dastgheib SA, Habib A. A single-amino-acid in-frame deletion in CYP17A1 results in combined 17-hydroxylase and 17,20-lyase deficiency in an Iranian family despite the protein mutation site. Hum Genome Var 2021; 8:31. [PMID: 34290232 PMCID: PMC8295247 DOI: 10.1038/s41439-021-00160-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 06/03/2021] [Accepted: 06/24/2021] [Indexed: 11/24/2022] Open
Abstract
In this study, we detected homozygous mutations in the CYP17A1 gene (NM_000102.4:c.1053_1055delCCT; p.Leu353del; SCV001479329) in a 28-year-old female patient (46,XX) and her phenotypically female 30-year-old sister (46,XY) who had phenotypes consistent with combined 17-hydroxylase and 17,20-lyase deficiency. The phenotypes were not expected based on the location of the mutation in the CYP17A1 redox partner-binding site and a previous description of the same mutation linked with isolated 17,20-lyase deficiency.
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Affiliation(s)
- Ashkan Habib
- School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | | | | | - Hossein Jafari Khamirani
- Department of Medical Genetics, Shiraz University of Medical Sciences, Shiraz, Iran.,Comprehensive Medical Genetic Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Sina Zoghi
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
| | | | - Asadollah Habib
- Department of Endocrinology, School of Medicine, Kazerun Branch, Islamic Azad University, Kazerun, Iran.
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Lee HI, Kwon A, Suh JH, Choi HS, Song KC, Chae HW, Kim HS. Two cases of 17α-hydroxylase/17,20-lyase deficiency caused by the CYP17A1 mutation. Ann Pediatr Endocrinol Metab 2021; 26:66-70. [PMID: 33819959 PMCID: PMC8026339 DOI: 10.6065/apem.2040184.092] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Accepted: 09/28/2020] [Indexed: 12/13/2022] Open
Abstract
17α-hydroxylase/17,20-lyase deficiency, caused by mutations in the cytochrome P450 family 17 subfamily A member 1 gene (CYP17A1), is an extremely rare form of congenital adrenal hyperplasia that is characterized by diverse phenotypes resulting from specific mutations. Here, we report 2 phenotypic females with 17α-hydroxylase/17,20-lyase deficiency: one with the 46,XX karyotype presenting primary amenorrhea and sexual infantilism, and the other with the 46,XY karyotype presenting a disorder of sexual development. In both cases, the serum levels of adrenocorticotropic hormone, 11-deoxycorticosterone, and gonadotropin were elevated, whereas the levels of testosterone and dehydroepiandrosterone were reduced. Next-generation sequencing revealed one patient with compound heterozygosity for p.Trp17Ter (c.51G>A) and p.His373Leu (c.1118A>T), and the other with homozygosity for p.His373Leu (c.1118A>T). This report further describes 2 cases of 17α-hydroxylase/17,20-lyase deficiency in patients who harbored a p.His373Leu substitution, commonly found in Korean individuals, and presented diverse phenotypes.
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Affiliation(s)
- Hae In Lee
- Department of Pediatrics, Severance Children's Hospital, Endocrine Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Ahreum Kwon
- Department of Pediatrics, Severance Children's Hospital, Endocrine Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Jung Hwan Suh
- Department of Pediatrics, Severance Children's Hospital, Endocrine Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Han Saem Choi
- Department of Pediatrics, Severance Children's Hospital, Endocrine Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Kyung Chul Song
- Department of Pediatrics, Severance Children's Hospital, Endocrine Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Hyun Wook Chae
- Department of Pediatrics, Severance Children's Hospital, Endocrine Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Ho-Seong Kim
- Department of Pediatrics, Severance Children's Hospital, Endocrine Research Institute, Yonsei University College of Medicine, Seoul, Korea,Address for correspondence: Ho-Seong Kim Department of Pediatrics, Severance Children’s Hospital, Endocrine Research Institute, Yonsei University College of Medicine, 501 Yonseiro, Seodaemungu, Seoul 03722, Korea
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17
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Guo X, Wang H, Xiang Y, Ren X, Jiang S. A rare intronic mutation in the splice acceptor site of the CYP17A1 gene in a patient with 17α-hydroxylase/17,20-lyase deficiency. Gynecol Endocrinol 2021; 37:97-100. [PMID: 32945709 DOI: 10.1080/09513590.2020.1822799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
Mutations of the CYP17A1 gene could cause complete or partial and combined or isolated 17α-hydroxylase/17,20-lyase deficiency (17OHD), which is characterized by hypertension, hypokalemia, and abnormal development of the genitalia. Most of the mutations are located in the coding sequence, and very few are located in the intronic region. The aim of this study is to investigate the novel intronic CYP17A1 mutation and its possible influence on phenotype. A 30-year-old Chinese female patient (46, XY) was referred to our Urology Department for severe hypertension, hypokalemia and a right adrenal mass. Physical examination revealed a hypertrophic clitoris and blind-ending vagina. Hormone analysis exhibited increased concentrations of ACTH and low levels of cortisol and sexual steroids. Mutation analysis revealed compound heterozygous CYP17A1 mutations, with c.1072C > T (p.Arg358*) in one allele and a novel intronic splicing mutation (c.970-1G > A) in another allele. Bioinformatics software predicted that the novel mutation may activate a cryptic splice site, shifting the reading frame and introducing a premature stop codon. In conclusion, we discovered a novel splicing mutation of the CYP17A1 gene in a Chinese patient with 17OHD. Our study extended the CYP17A1 mutation spectrum and provided valuable information for patient management and genetic counseling.
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Affiliation(s)
- Xudong Guo
- Department of Urology, Shandong Provincial Hospital, affiliated to Shandong First Medical University, Jinan, China
| | - Hanbo Wang
- Department of Urology, Shandong Provincial Hospital, affiliated to Shandong First Medical University, Jinan, China
| | - Yuzhu Xiang
- Department of Urology, Shandong Provincial Hospital, affiliated to Shandong First Medical University, Jinan, China
| | - Xiangbin Ren
- Department of Urology, Shandong Provincial Hospital, affiliated to Shandong First Medical University, Jinan, China
| | - Shaobo Jiang
- Department of Urology, Shandong Provincial Hospital, affiliated to Shandong First Medical University, Jinan, China
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Asirvatham AR, Balachandran K, Jerome P, Venkatesan V, Koshy T, Mahadevan S. Clinical, biochemical and genetic characteristics of children with congenital adrenal hyperplasia due to 17α-hydroxylase deficiency. J Pediatr Endocrinol Metab 2020; 33:/j/jpem.ahead-of-print/jpem-2020-0050/jpem-2020-0050.xml. [PMID: 32651986 DOI: 10.1515/jpem-2020-0050] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Accepted: 04/17/2020] [Indexed: 01/18/2023]
Abstract
Objectives Congenital adrenal hyperplasia (CAH) is an autosomal recessive disorder, that could rarely be due to 17 α-hydroxylase deficiency (17αOHD) and/or 17,20 lyase deficiency. Mutation of CYP17A1 gene causes deficiency of glucocorticoids and androgens but excess of mineralocorticoids. Lack of genital ambiguity in most children causes a delay in diagnosis even until puberty. Classical presentation with hypertension and hypokalemia is often not encountered. We intended to study the clinical, biochemical and genetic characteristics of children diagnosed with CAH due to 17αOHD. Methods Three children who were diagnosed with CAH due to 17αOHD in our institute and on follow up were included in this retrospective study. Clinical, biochemical and genetic characteristics of these children were retrieved and studied from electronic medical records. Results Two children were genetic females and one was genetic male, but all three were raised as females. All had hypertension at diagnosis except one but none had hypokalemia. All of them had mutation in the CYP17A1 gene. The two females responded well to oestrogen and progesterone and had adequate estrogenization clinically. Conclusions Even though CAH due to 17αOHD is quite rare, it should be considered while evaluating young individuals with hypogonadism, hypertension with or without hypokalemia. Lack of genital ambiguity and absence of classical signs at presentation does not rule out this not so uncommon condition and warrants follow up.
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Affiliation(s)
- Adlyne Reena Asirvatham
- Department of Endocrinology, Sri Ramachandra Medical College and Research Institute, Chennai, India
| | - Karthik Balachandran
- Department of Endocrinology, Sri Ramachandra Medical College and Research Institute, Chennai, India
| | - Packiamary Jerome
- Department of Medicine, Neyveli Lignite Corporation Hospital, Neyveli, India
| | - Vettriselvi Venkatesan
- Department of Genetics, Sri Ramachandra Medical College and Research Institute, Chennai, India
| | - Teena Koshy
- Department of Genetics, Sri Ramachandra Medical College and Research Institute, Chennai, India
| | - Shriraam Mahadevan
- Department of Endocrinology, Sri Ramachandra Medical College and Research Institute, Chennai, India
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Sousa Paredes SCD, Marques O, Alves M. Partial deficiency of 17α-hydroxylase: a rare cause of congenital adrenal hyperplasia. BMJ Case Rep 2019; 12:12/12/e230778. [PMID: 31801776 DOI: 10.1136/bcr-2019-230778] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Congenital adrenal hyperplasia (CAH) due to 17α-hydroxylase deficiency, a rare CAH syndrome, is characterised by failure to synthetise cortisol, adrenal androgens and gonadal steroids. The partial deficiency is much rarer, presenting with subtler symptoms. Failure to reach a proper diagnosis causes inappropriate hypertension treatment and impairs the development of secondary sexual characteristics. We report a case of a 30-year-old woman transferred to an endocrinology clinic for evaluation of autoimmune thyroiditis. She was started on oral contraceptives at the age of 13 due to oligomenorrhea and presented underdeveloped pubic and axillar hair and Tanner stage 3 breast development. Biochemical tests evidenced very low androgens levels and genetic analysis confirmed a CAH due to 17α-hydroxylase deficiency. Partial 17α-hydroxylase deficiency is a rare clinical entity, nevertheless, it should be included in the differential diagnosis of menstrual disorders.
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Affiliation(s)
| | | | - Marta Alves
- Endocrinology, Hospital de Braga, Braga, Portugal
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20
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Chen H, Yuan K, Zhang B, Jia Z, Chen C, Zhu Y, Sun Y, Zhou H, Huang W, Liang L, Yan Q, Wang C. A Novel Compound Heterozygous CYP17A1 Variant Causes 17α-Hydroxylase/17, 20-Lyase Deficiency. Front Genet 2019; 10:996. [PMID: 31695722 PMCID: PMC6817513 DOI: 10.3389/fgene.2019.00996] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Accepted: 09/18/2019] [Indexed: 12/16/2022] Open
Abstract
Background: Congenital adrenal hyperplasia (CAH) encompasses a group of autosomal recessive diseases characterized by enzyme deficiencies, within steroid hormone anabolism, which lead to disorders in cortisol synthesis. The 17α-hydroxylase/17,20-lyase deficiency (17-OHD) is an uncommon form of CAH caused by variants in the CYP17A1 gene. Aims: We report a novel compound heterozygous CYP17A1 variant and its association with the pathogenesis of 17-OHD. Methods: The patient was assessed for medical history, clinical manifestations, physical examination, laboratory examination, karyotype analysis, and adrenal computed tomography. Mutation screening was conducted using whole-exome sequencing (WES) and Sanger sequencing. The wild-type and mutant CYP17A1 complementary DNAs (cDNAs) were amplified and cloned into a pcDNA3.1(+) vector. These plasmids were transfected transiently into HEK-293T cells. Quantitative PCR and Western blotting analysis were performed to measure the expression level of P450c17. An enzymatic activity assay was conducted to measure the content of 17-hydroxyprogesterone (17-OHP) and dehydroepiandrosterone (DHEA) in medium using liquid chromatography–tandem mass spectrometry (LC-MS/MS). Results: The proband was characterized by 17-OHD with rhabdomyolysis, hypokalemia, and adrenal insufficiency. Novel compound heterozygous variants of the CYP17A1 gene (c.1304T > C/p.Phe435Ser and c.1228delG/p.Asp410Ilefs*9) were identified. The enzymatic activity assay revealed that this variant resulted in a complete deficiency of 17α-hydroxylase and 17,20-lyase activity. This was consistent with the hormonal characteristics of the proband’s blood. Conclusions: These results suggest that the compound heterozygous variant of c.1304T > C and c.1228delG of the CYP17A1 gene can lead to 17-OHD. Our findings thus provide a novel insight into the clinical evaluations and molecular basis of 17-OHD.
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Affiliation(s)
- Hong Chen
- Department of Pediatrics, The First Affiliated Hospital, College of Medicine Zhejiang University, Hangzhou, China
| | - Ke Yuan
- Department of Pediatrics, The First Affiliated Hospital, College of Medicine Zhejiang University, Hangzhou, China
| | - Bingtao Zhang
- College of Life Science, Zhejiang University, Hangzhou, China
| | - Zexiao Jia
- College of Life Science, Zhejiang University, Hangzhou, China
| | - Chun Chen
- Department of Pediatrics, The First Affiliated Hospital, College of Medicine Zhejiang University, Hangzhou, China
| | - Yilin Zhu
- Department of Pediatrics, The First Affiliated Hospital, College of Medicine Zhejiang University, Hangzhou, China
| | - Yaping Sun
- College of Life Science, Zhejiang University, Hangzhou, China
| | - Hui Zhou
- College of Life Science, Zhejiang University, Hangzhou, China
| | - Wendong Huang
- Department of Diabetes Complications and Metabolism, The Beckman Research Institute, City of Hope National Medical Center, Duarte, CA, United States
| | - Li Liang
- Department of Pediatrics, The First Affiliated Hospital, College of Medicine Zhejiang University, Hangzhou, China
| | - Qingfeng Yan
- Department of Pediatrics, The First Affiliated Hospital, College of Medicine Zhejiang University, Hangzhou, China.,College of Life Science, Zhejiang University, Hangzhou, China.,Key Laboratory for Cell and Gene Engineering of Zhejiang Province, Hangzhou, China
| | - Chunlin Wang
- Department of Pediatrics, The First Affiliated Hospital, College of Medicine Zhejiang University, Hangzhou, China
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21
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Yang F, Zhao Y, Lv J, Sheng X, Wang L. A new compound heterozygous mutation in a female with 17α-hydroxylase/17,20-lyase deficiency, slipped capital femoral epiphysis, and adrenal myelolipoma. Gynecol Endocrinol 2019; 35:385-389. [PMID: 30614301 DOI: 10.1080/09513590.2018.1540576] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
17α-Hydroxylase/17,20-lyase deficiency (17-OHD) is a rare disease caused by mutations of the CYP17A1 gene. Slipped capital femoral epiphysis (SCFE) rarely occurs in adults. There are occasional reports of adrenal myelolipoma (AML) in 17-OHD. A 27-year-old Chinese female (46, XX) visited the hospital for SCFE and presented with continuous hypokalemia, absent spontaneous puberty, and hypertension. Hypergonadotropic hypogonadism was detected. The laboratory tests were consistent with 17-OHD. AML was considered based on the imaging examinations. A mutation analysis of the CYP17A1 gene identified the following compound heterozygous mutation: a frame-shift mutation, i.e. c.985_987delTACinsAA (p.Tyr329fs), that had been reported to be a common mutation in the Chinese population was found in exon 6. Another new nonsense mutation, i.e. c.1270C > T (p.Gln424*), that causes a premature termination codon was found in exon 8. Treatment with prednisone had poor efficacy. The administration of 0.75 mg dexamethasone and estradiol/dydrogesterone cyclic treatment significantly improved the patient's symptoms. For the first time, we report a 17-OHD case accompanied by SCFE, AML, and a novel mutation site in the CYP17A1 gene. We provide insight into the clinical manifestations, genetic analysis, and treatment options of 17-OHD.
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Affiliation(s)
- Fan Yang
- a Department of Endocrinology , The Second Affiliated Hospital of Harbin Medical University , Harbin , PR China
| | - Yongting Zhao
- a Department of Endocrinology , The Second Affiliated Hospital of Harbin Medical University , Harbin , PR China
| | - Jie Lv
- a Department of Endocrinology , The Second Affiliated Hospital of Harbin Medical University , Harbin , PR China
| | - Xia Sheng
- a Department of Endocrinology , The Second Affiliated Hospital of Harbin Medical University , Harbin , PR China
| | - Lihong Wang
- a Department of Endocrinology , The Second Affiliated Hospital of Harbin Medical University , Harbin , PR China
- b Translational Medicine Research and Cooperation Center of Northern China , Heilongjiang Academy of Medical Sciences , Harbin , China
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Mo EY, Lee JY, Kim SY, Kim MJ, Kim ES, Lee S, Han JH, Moon SD. Functional Identification of Compound Heterozygous Mutations in the CYP17A1 Gene Resulting in Combined 17α-Hydroxylase/17,20-Lyase Deficiency. Endocrinol Metab (Seoul) 2018; 33:413-422. [PMID: 30229581 PMCID: PMC6145962 DOI: 10.3803/enm.2018.33.3.413] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Revised: 06/08/2018] [Accepted: 06/27/2018] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND We previously reported a patient with congenital adrenal hyperplasia (CAH) with compound heterozygous mutations in the cytochrome P450 17A1 (CYP17A1) gene. One allele had a p.His373Leu and the other a new p.Glu383fsX36 mutation. The aim of this study was to investigate the functional properties of a new allele present in a compound heterozygote of CYP17A1. METHODS To understand how p.His373Leu and p.Glu383fsX36 affect P450c17 enzymatic activity, wild type and mutant CYP17A1 cDNAs were cloned into flag-tagged pcDNA3 vector and introduced into human embryonic kidney cells 293T (HEK293T) cells. Protein expression levels of CYP17A1 were then analyzed. And the activities of 17α-hydroxylase and 17,20-lyase of CYP17A1 were evaluated by measuring the conversion of progesterone to 17α-hydroxyprogesterone and of 17α-hydroxypregnenolone to dehydroepiandrosterone, respectively. In addition a computer model was used to create the three-dimensional structure of the mutant CYP17A1 enzymes. RESULTS Production of the p.His373Leu mutant protein was significantly lower than that of the wild type protein, and the p.Glu383fsX36 protein was hardly produced. Similarly the enzymatic activity derived from the p.His373Leu mutant vector was significantly lower than that obtained from the wild type vector, and little activity was obtained from the p.Glu383fsX36 vector. Three-dimensional modeling of the enzyme showed that p.His373 was located in region important for heme-binding and proper folding. Neither the p.His373Leu nor the p.Glu383fsX36 mutant protein formed a heme-binding structure. CONCLUSION Enzyme activity measured in both mutants disappeared completely in both 17α-hydroxylase and 17,20-lyase. This result accounts for the clinical manifestations of the patient with the compound heterozygous CYP17A1 mutations.
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Affiliation(s)
- Eun Yeong Mo
- Department of Internal Medicine, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Incheon, Korea
| | - Ji Young Lee
- Department of Internal Medicine, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Incheon, Korea
| | - Su Yeon Kim
- Department of Internal Medicine, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Incheon, Korea
| | - Min Ji Kim
- Department of Internal Medicine, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Incheon, Korea
| | - Eun Sook Kim
- Department of Internal Medicine, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Incheon, Korea
| | - Seungok Lee
- Department of Laboratory Medicine, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Incheon, Korea
| | - Je Ho Han
- Department of Internal Medicine, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Incheon, Korea
| | - Sung Dae Moon
- Department of Internal Medicine, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Incheon, Korea.
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Wei HL, Lu S, Wang XL, Li JW, Cui YP, Yao YS. [17α-Hydroxylase deficiency with severe hypertension as the initial symptom in a child]. ZHONGGUO DANG DAI ER KE ZA ZHI = CHINESE JOURNAL OF CONTEMPORARY PEDIATRICS 2018; 20:675-679. [PMID: 30111479 PMCID: PMC7389758 DOI: 10.7499/j.issn.1008-8830.2018.08.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Accepted: 05/30/2018] [Indexed: 06/08/2023]
Abstract
A 14-year-old female (social gender) patient was admitted to the hospital due to severe hypertension for 11 days. The patient had primary amenorrhea. The blood pressure was 146/90 mm Hg. The skin color was slightly black. The development of secondary sexual characteristics was poor. The labia majora could be observed in the vulva. However, the labia minora, clitoris, vagina, and hymen were absent. The levels of renin, cortisol, and sex hormone were low, while the levels of adrenocorticotropic hormone and gonadotropin were high. The levels of blood potassium and aldosterone were both normal. Radiography indicated retardation of bone age. Ultrasound examination revealed that the ovary and uterus were both absent. The patient had bilateral adrenal hyperplasia and cryptorchid testes located in both inguinal canals. The patient had a 46,XY karyotype. Whole genome sequencing revealed two homozygous mutations, c.985T>C and c.987delC, in exon 6 of the CYP17A1 gene of the patient and heterozygous mutations in the same sites of the parents. The patient was diagnosed with congenital adrenal hyperplasia-17α-hydroxylase deficiency. After treatment with hydrocortisone for 2 months, blood pressure returned to normal and the level of adrenocorticotropic hormone was reduced. According to the request of the patient and the parents, hydrocortisone was replaced with estrogen to allow the patient to live as a female. The patient also received surgical excision of cryptorchid testes to prevent gonadal malignancy. It is concluded that in the differential diagnosis of pediatric hypertension, sexual development should be considered and the levels of adrenocorticotropic hormone and cortisol should be evaluated. The rare disease 17α-hydroxylase deficiency should be considered for patients with low-renin hypertension and gonadal dysgenesis.
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Affiliation(s)
- Hong-Ling Wei
- Department of Pediatrics, Peking University Third Hospital, Beijing 100191, China.
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24
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Zhang C, Liu XR, Cao YC, Tian JL, Zhen D, Luo XF, Wang XM, Tian JH, Gao JM. Mammalian target of rapamycin/eukaryotic initiation factor 4F pathway regulates follicle growth and development of theca cells in mice. Reprod Fertil Dev 2018; 29:768-777. [PMID: 26748416 DOI: 10.1071/rd15230] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2015] [Accepted: 11/26/2015] [Indexed: 01/25/2023] Open
Abstract
The aim of the present study was to clarify the roles of the mammalian target of rapamycin (mTOR) signalling pathway in follicular growth and development of thecal cells. Using in vivo-grown and in vitro-cultured ovaries, histological changes were evaluated using haematoxylin and eosin (HE) staining. Differentially expressed genes (DEGs) from 0 day post partum (d.p.p.) to 8 d.p.p. ovaries were screened by microarray and verified by quantitative real-time polymerase chain reaction. Forty-two DEGs related to cell proliferation and differentiation were screened out, with most DEGs being related to the to mTOR signalling pathway. Then, 3 d.p.p. ovaries were retrieved and used to verify the role of mTOR signalling in follicle and thecal cell development using its activators (Ras homologue enriched in brain (Rheb) and GTP) and inhibitor (rapamycin). The development of follicles and thecal cells was significantly impaired in ovaries cultured in vitro Day 3 to Day 8. In in vitro-cultured ovaries, Rheb and GTP (is 100ngmL-1 Rheb and 500ngmL-1 GTP for 48h) significantly increased follicle diameter, the percentage of primary and secondary follicles and the umber of thecal cells, and upregulated expression of mTOR, phosphorylated eukaryotic translation initiation factor 4E-binding protein 1 (4EBP1), eukaryotic initiation factor (eIF) 4F and cytochrome P450, family 17, subfamily A, polypeptide 1 (CYP17A1). Rapamycin (10nM rapamycin for 24h) had opposite effects to those of Rheb and GTP, and partly abrogated (significant) the effects of Rheb and GTP when added to the culture in combination with these drugs. Thus, mTOR signalling plays an important role in follicle growth and thecal cell development.
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Affiliation(s)
- Chao Zhang
- Animal Science and Technology College, Beijing University of Agriculture, Beijing 102206, China
| | - Xiao-Ran Liu
- Galactophore Breast Clinic, Peking University School of Oncology, Beijing 100142, China
| | - Yong-Chun Cao
- Animal Science and Technology College, Beijing University of Agriculture, Beijing 102206, China
| | - Jin-Ling Tian
- Animal Science and Technology College, Beijing University of Agriculture, Beijing 102206, China
| | - Di Zhen
- Animal Science and Technology College, Beijing University of Agriculture, Beijing 102206, China
| | - Xiao-Fei Luo
- Animal Science and Technology College, Beijing University of Agriculture, Beijing 102206, China
| | - Xin-Mei Wang
- Animal Science and Technology College, Beijing University of Agriculture, Beijing 102206, China
| | - Jian-Hui Tian
- College of Animal Science and Technology, China Agricultural University, Beijing 100083, China
| | - Jian-Ming Gao
- Animal Science and Technology College, Beijing University of Agriculture, Beijing 102206, China
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25
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Zhang Y, Zhang X, Wang Y, Hua K, Ding J. Genetic defect of a combined 17 α-hydroxylase/17,20-lyase deficiency patient with adrenal crisis. Gynecol Endocrinol 2018; 34:540-544. [PMID: 29345162 DOI: 10.1080/09513590.2017.1417981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
Combined 17 α-hydroxylase/17,20-lyase deficiency (17OHD) is a rare autosomal recessive disease that is a type of congenital adrenal hyperplasia, which results in hypertension, hypokalemia, sexual infantilism, primary amenorrhea in females (46,XX), or pseudohermaphroditism in males (46,XY). It is mainly caused by mutation in the CYP17A1 gene, which encodes a key enzyme in the steroidogenic pathway. However, these patients rarely experience adrenal crisis, due to abnormally high corticosterone levels. Here, we report a 17OHD patient who experienced clinical adrenal crisis on day 1 after gonadectomy. Her (46,XY) genetic defect was c0.715 C > T p.Arg239-stop in exon 4 of CYP17A1, which was confirmed by targeted sequence capture/high-throughput sequencing and Sanger sequencing technology. To the best of our knowledge, 17OHD with adrenal crisis has not been reported previously, and the reason why it arose in this patient might have been inappropriate glucocorticoid administration during the perioperative period.
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Affiliation(s)
- Yunqiang Zhang
- a Department of Gynecology , The Obstetrics and Gynecology Hospital , Shanghai , PR China
- b Shanghai Key Laboratory of Female Reproductive Endocrine-Related Diseases , The Obstetrics and Gynecology Hospital, Fudan University , Shanghai , PR China
| | - Xuyin Zhang
- a Department of Gynecology , The Obstetrics and Gynecology Hospital , Shanghai , PR China
- b Shanghai Key Laboratory of Female Reproductive Endocrine-Related Diseases , The Obstetrics and Gynecology Hospital, Fudan University , Shanghai , PR China
| | - Yiqun Wang
- c Department of Gynecology , Zhenjiang Maternal and Infant Hospital , Zhenjiang , PR China
| | - Keqin Hua
- a Department of Gynecology , The Obstetrics and Gynecology Hospital , Shanghai , PR China
- b Shanghai Key Laboratory of Female Reproductive Endocrine-Related Diseases , The Obstetrics and Gynecology Hospital, Fudan University , Shanghai , PR China
| | - Jingxin Ding
- a Department of Gynecology , The Obstetrics and Gynecology Hospital , Shanghai , PR China
- b Shanghai Key Laboratory of Female Reproductive Endocrine-Related Diseases , The Obstetrics and Gynecology Hospital, Fudan University , Shanghai , PR China
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Kitajima M, Miura K, Inoue T, Murakami Y, Kitajima Y, Murakami N, Taniguchi K, Yoshiura KI, Masuzaki H. Two consecutive successful live birth in woman with 17α hydroxylase deficiency by frozen-thaw embryo transfer under hormone replacement endometrium preparation. Gynecol Endocrinol 2018; 34:381-384. [PMID: 29068264 DOI: 10.1080/09513590.2017.1393512] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
17α-Hydroxylase deficiency is rare autosomal recessive disorder that manifested by hypertension, hypokalemia, delayed sexual development, primary amenorrhea and infertility. The information regarding infertility care and conception in women with this disorder are extremely limited. We report a 24-year-old Japanese woman with primary amenorrhea who was diagnosed as partial 17α-hydroxylase deficiency caused by homozygous 3 bp deletion in exon 1 of 17α-hydroxylase gene. In vitro fertilization with controlled ovarian stimulation was carried out and all viable embryo were frozen. During ovarian stimulation, serum progesterone levels were markedly elevated, and endometrial growth was impaired. Utilizing frozen-thaw embryo transfer under hormonal replacement (glucocorticoid, estradiol and progesterone), she had successfully given two consecutive live birth. Women with 17α-hydroxylase deficiency with residual ovarian reserve can afford reproductive success by appropriate diagnosis and treatment by assisted reproductive technology.
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Affiliation(s)
- Michio Kitajima
- a Department of Obstetrics and Gynecology , Nagasaki University Graduate School of Biomedical Sciences , Nagasaki , Japan
| | - Kiyonori Miura
- a Department of Obstetrics and Gynecology , Nagasaki University Graduate School of Biomedical Sciences , Nagasaki , Japan
| | - Tsuneo Inoue
- a Department of Obstetrics and Gynecology , Nagasaki University Graduate School of Biomedical Sciences , Nagasaki , Japan
| | - Yuko Murakami
- a Department of Obstetrics and Gynecology , Nagasaki University Graduate School of Biomedical Sciences , Nagasaki , Japan
| | - Yuriko Kitajima
- a Department of Obstetrics and Gynecology , Nagasaki University Graduate School of Biomedical Sciences , Nagasaki , Japan
| | - Naoko Murakami
- a Department of Obstetrics and Gynecology , Nagasaki University Graduate School of Biomedical Sciences , Nagasaki , Japan
| | - Ken Taniguchi
- a Department of Obstetrics and Gynecology , Nagasaki University Graduate School of Biomedical Sciences , Nagasaki , Japan
| | - Ko-Ichiro Yoshiura
- b Department of Human Genetics , Nagasaki University Graduate School of Biomedical Sciences , Nagasaki , Japan
| | - Hideaki Masuzaki
- a Department of Obstetrics and Gynecology , Nagasaki University Graduate School of Biomedical Sciences , Nagasaki , Japan
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27
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Alswailem MM, Alzahrani OS, Alhomaidah DS, Alasmari R, Qasem E, Murugan AK, Alsagheir A, Brema I, Abbas BB, Almehthel M, Almeqbali A, Alzahrani AS. Mutational analysis of rare subtypes of congenital adrenal hyperplasia in a highly inbred population. Mol Cell Endocrinol 2018; 461:105-111. [PMID: 28870780 DOI: 10.1016/j.mce.2017.08.022] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2017] [Revised: 08/30/2017] [Accepted: 08/31/2017] [Indexed: 11/16/2022]
Abstract
CONTEXT Apart from 21 Hydroxylase deficiency, other subtypes of congenital adrenal hyperplasia (CAH) are rare. We studied the clinical features and molecular genetics of a relatively large series of patients with CYP17A1, HSD3β2 and StAR deficiencies. PATIENTS AND METHODS We studied 21 patients including 7 patients with CYP17A1, 10 patients with HSD3β2 and 4 patients with StAR deficiencies. For mutation detection, we isolated DNA from peripheral leucocytes, amplified genes of interest using polymerase chain reaction and directly sequenced the amplicons using Dideoxy Chain Termination method. RESULTS Regardless of their karyotype, patients with CYP17A1 deficiency presented with normally looking external female genitalia and were raised as females. Hypertension and hypokalemia were prominent features in 4 of 7 patients. Two missense (p.R416H, p.R239Q) and 2 non-sense (p.Y329X, p.Y329X) mutations were found in these 7 cases. In 3 unrelated families with 10 affected siblings with HSD3β2 mutations, two non-sense mutations were found (p.Q334X, p.R335X). 46XY patients with HSD3β2 deficiency presented with ambiguous genitalia while 46XX patients presented with normal female external genitalia. Adrenal crisis was common in patients with both karyotypes. In the 4 patients with StAR deficiency, both genetic male and female patients presented with normally looking female external genitalia and adrenal crisis. One previously reported missense mutation (p.R182H) was found in 3 unrelated patients and a novel non-sense mutation (p.Q264X) in the fourth patient. CONCLUSIONS These cases of rare subtypes of CAH illustrate the heterogeneous phenotypic and genetic features of these subtypes and add unique novel mutations to the previously known ones.
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Affiliation(s)
- Meshael M Alswailem
- Department of Molecular Oncology, King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia
| | - Ohoud S Alzahrani
- Department of Pediatrics, King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia
| | - Doha S Alhomaidah
- Department of Pediatrics, King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia
| | - Rahma Alasmari
- Department of Pediatrics, King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia
| | - Ebtesam Qasem
- Department of Molecular Oncology, King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia
| | | | - Afaf Alsagheir
- Department of Pediatrics, King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia
| | - Imad Brema
- Department of Medicine, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Bassam Ben Abbas
- Department of Pediatrics, King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia
| | - Mohammed Almehthel
- Department of Medicine, King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia
| | - Ali Almeqbali
- National Diabetic and Endocrine Center, Muscat, Oman
| | - Ali S Alzahrani
- Department of Molecular Oncology, King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia; Department of Medicine, King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia.
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Fontenele R, Costa-Santos M, Kater CE. 17α-HYDROXYLASE DEFICIENCY IS AN UNDERDIAGNOSED DISEASE: HIGH FREQUENCY OF MISDIAGNOSES IN A LARGE COHORT OF BRAZILIAN PATIENTS. Endocr Pract 2017; 24:170-178. [PMID: 29144824 DOI: 10.4158/ep171987.or] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE 17α-Hydroxylase deficiency (P450c17D) is characterized by hypogonadism and mineralocorticoid hypertension. We aimed to estimate the relative incidence and spectrum of preliminary misdiagnoses in Brazilian P450c17D patients. METHODS In this cross-sectional study, we reviewed, updated, and analyzed data of 40 P450c17D patients (21 XY, 19 XX). RESULTS Complete data were unavailable for 2 patients. Seven patients were relatives of an index case. Of the 31 index cases, 29 (94%) received a total of 16 misdiagnoses (1-4 per patient) before confirmation of P450c17D. Essential hypertension (55%), pure gonadal dysgenesis (35%), and androgen resistance syndrome (21%) were the most frequent misdiagnoses. Median ages at initial and final diagnosis were 13.2 and 16.5 years, respectively, with an average interval to diagnosis of 3.2 years. Initially, 38 (95%) patients had hypertension, and 75% had hypokalemia. Primary amenorrhea and sexual infantilism were present in 95% patients, and 73% were at Tanner stage I. All had low-to-undetectable estrogens and androgens with elevated gonadotropins and progesterone (580 ± 53 ng/dL). Several had recurrent infections in childhood and neurological issues prior to final diagnosis and/or had siblings who died of infectious diseases or unknown causes before puberty. CONCLUSION The high percentage of prior misdiagnoses in P450c17D patients may be attributable to the rarity of and relative unfamiliarity with the disease, its varied clinical presentation, and the limited access to critical steroid dosages and genotyping. Reduced sex steroids, and elevated gonadotropins and progesterone levels, in addition to mineralocorticoid hypertension, are pathognomonic of P450c17D. CYP17A1 gene mutations provide a definitive diagnosis. ABBREVIATIONS ACTH = adrenocorticotropic hormone CAH = congenital adrenal hyperplasia CYP17A1 = 17α-hydroxylase enzyme DOC = deoxycorticosterone HH = hypergonadotropic hypogonadism P450c17D = 17α-hydroxylase deficiency TS = Tanner stage.
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Bhatt MR, Khatri Y, Rodgers RJ, Martin LL. Role of cytochrome b5 in the modulation of the enzymatic activities of cytochrome P450 17α-hydroxylase/17,20-lyase (P450 17A1). J Steroid Biochem Mol Biol 2017; 170:2-18. [PMID: 26976652 DOI: 10.1016/j.jsbmb.2016.02.033] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2015] [Revised: 02/25/2016] [Accepted: 02/27/2016] [Indexed: 12/13/2022]
Abstract
Cytochrome b5 (cyt b5) is a small hemoprotein that plays a significant role in the modulation of activities of an important steroidogenic enzyme, cytochrome P450 17α-hydroxylase/17,20-lyase (P450 17A1, CYP17A1). Located in the zona fasciculata and zona reticularis of the adrenal cortex and in the gonads, P450 17A1 catalyzes two different reactions in the steroidogenic pathway; the 17α-hydroxylation and 17,20-lyase, in the endoplasmic reticulum of these respective tissues. The activities of P450 17A1 are regulated by cyt b5 that enhances the 17,20-lyase reaction by promoting the coupling of P450 17A1 and cytochrome P450 reductase (CPR), allosterically. Cyt b5 can also act as an electron donor to enhance the 16-ene-synthase activity of human P450 17A1. In this review, we discuss the many roles of cyt b5 and focus on the modulation of CYP17A1 activities by cyt b5 and the mechanisms involved.
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Affiliation(s)
- Megh Raj Bhatt
- Everest Biotech Pvt. Ltd., Khumaltar, Lalitpur, P.O. Box 21608, Kathmandu 44600, Nepal
| | - Yogan Khatri
- Institute of Biochemistry, Saarland University, 66123 Saarbrücken, Germany
| | - Raymond J Rodgers
- School of Medicine, Robinson Research Institute, University of Adelaide, Adelaide SA 5005, Australia
| | - Lisandra L Martin
- School of Chemistry, Monash University, Clayton, 3800, Victoria, Australia.
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Çamtosun E, Şıklar Z, Ceylaner S, Kocaay P, Berberoğlu M. Delayed Diagnosis of a 17-Hydroxylase/17,20-Lyase Deficient Patient Presenting as a 46,XY Female: A Low Normal Potassium Level Can Be an Alerting Diagnostic Sign. J Clin Res Pediatr Endocrinol 2017; 9:163-167. [PMID: 28008861 PMCID: PMC5463290 DOI: 10.4274/jcrpe.3839] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
17-hydroxylase/17,20-lyase deficiency (17-OHD), a rare autosomal recessive defect in adrenal and gonadal steroidogenesis, causes absence of secondary sexual characteristics and frequently associated with hypertension and hypokalemia. Here, we report a 46,XY case who had normal potassium levels and no hypertension. Our patient was a 2.5-year-old female admitted with female external genitalia and inguinal swelling. Pathology of biopsy revealed that this gonad was a testis. Karyotype was 46,XY. She had no hypertension and no hypokalemia. Serum luteinizing hormone and follicle-stimulating hormone levels were high; testosterone, dehydroepiandrosterone sulfate, and androstenedione were low. Human chorionic gonadotrophin stimulation resulted in partial testosterone response. She was initially diagnosed as partial gonadal dysgenesis or testosterone synthesis defect. In her follow-up after noticing low normal potassium levels at age 9 years, progesterone level was measured and detected to be high. Adrenocorticotropic hormone-stimulated steroid measurements were consistent with 17-OHD. Genetic analyses revealed p. R96Q (c.287G>A) homozygous mutation on exon 1 of CYP17A1 gene. In conclusion, evaluation of 46,XY disorder of sex development patients must include serum potassium levels, and near low levels of potassium levels should also suggest 17-OHD despite absence of hypertension or remarkable hypokalemia. Testosterone synthesis defects must be excluded before establishing the diagnosis of partial gonadal dysgenesis.
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Affiliation(s)
- Emine Çamtosun
- Ankara University Faculty of Medicine, Department of Pediatric Endocrinology, Ankara, Turkey, E-mail:
| | - Zeynep Şıklar
- Ankara University Faculty of Medicine, Department of Pediatric Endocrinology, Ankara, Turkey
| | | | - Pınar Kocaay
- Ankara University Faculty of Medicine, Department of Pediatric Endocrinology, Ankara, Turkey
| | - Merih Berberoğlu
- Ankara University Faculty of Medicine, Department of Pediatric Endocrinology, Ankara, Turkey
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Kim JH, Kang E, Heo SH, Kim GH, Jang JH, Cho EH, Lee BH, Yoo HW, Choi JH. Diagnostic yield of targeted gene panel sequencing to identify the genetic etiology of disorders of sex development. Mol Cell Endocrinol 2017; 444:19-25. [PMID: 28130116 DOI: 10.1016/j.mce.2017.01.037] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2016] [Revised: 01/21/2017] [Accepted: 01/23/2017] [Indexed: 10/20/2022]
Abstract
Disorders of sex development (DSD) vary phenotypically and are caused by a number of genetic etiologies. This study investigated the genetic etiology of DSD patients using targeted exome sequencing of 67 known DSD-associated genes in humans. This study included 37 patients with 46, XY DSD and seven patients with 46, XX DSD. We identified known pathogenic mutations or deletion in nine (20.5%) patients in the AR, CYP17A1, SRD5A1, and DMRT1/2 genes. Novel variants were identified in nine patients (20.5%) in the AR, ATRX, CYP17A1, CHD7, MAP3K1, NR5A1, and WWOX genes. Among them, four patients harbored pathogenic or likely pathogenic variants, while the remaining five patients (11.4%) had variants of uncertain significance. We were able to make a genetic diagnosis in 29.5% of patients with pathogenic or likely pathogenic mutations. Targeted exome sequencing is an efficient tool to improve the diagnostic yield of DSD, despite its phenotypic and genetic heterogeneity.
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Affiliation(s)
- Ja Hye Kim
- Department of Pediatrics, Hanyang University Guri Hospital, Hanyang University College of Medicine, Guri, Republic of Korea
| | - Eungu Kang
- Department of Pediatrics, Asan Medical Center Children's Hospital, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Sun Hee Heo
- Asan Institute for Life Sciences, Asan Medical Center Children's Hospital, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Gu-Hwan Kim
- Medical Genetics Center, Asan Medical Center Children's Hospital, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | | | - Eun-Hae Cho
- Green Cross Genome, Yongin, Republic of Korea
| | - Beom Hee Lee
- Department of Pediatrics, Asan Medical Center Children's Hospital, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Han-Wook Yoo
- Department of Pediatrics, Asan Medical Center Children's Hospital, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Jin-Ho Choi
- Department of Pediatrics, Asan Medical Center Children's Hospital, University of Ulsan College of Medicine, Seoul, Republic of Korea.
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Xu S, Hu S, Yu X, Zhang M, Yang Y. 17α‑hydroxylase/17,20‑lyase deficiency in congenital adrenal hyperplasia: A case report. Mol Med Rep 2016; 15:339-344. [PMID: 27959413 PMCID: PMC5355729 DOI: 10.3892/mmr.2016.6029] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2015] [Accepted: 11/11/2016] [Indexed: 12/13/2022] Open
Abstract
Congenital adrenal hyperplasia (CAH) is a rare autosomal recessive disorder caused by mutations in the cytochrome P450 family 17 subfamily A member 1 (CYP17A1) gene located on chromosome 10q24.3, which leads to a deficiency in 17α-hydroxylase/17,20-lyase. The disorder is characterized by low blood levels of estrogens, androgens and cortisol, which leads to a compensatory increase in adrenocorticotropic hormone levels that stimulate the production of mineralocorticoid precursors. This subsequently leads to hypertension, hypokalemia, primary amenorrhea and sexual infantilism. Over 90 distinct genetic lesions have been identified in patients with this disorder. The prevalence of common mutation of CYP17A1 gene differs among ethnic groups. Treatment of this disorder involves replacement of glucocorticoids and sex steroids. Estrogen alone is prescribed for patients who are biologically male with 17α-hydroxylase deficiencies that identify as female. However, genetically female patients may receive estrogen and progesterone supplementation. In the present study, a 17-year-old female with 17α-hydroxylase/17,20-lyase deficiency that presented with primary amenorrhea and sexual infantilism and no hypertension, was examined. The karyotype of the patient was 46, XX, and genetic analysis revealed the presence of a compound heterozygous mutation in exons 6 and 8, leading to the complete absence of 17α-hydroxylase/17,20-lyase activity. The patient was treated with prednisolone and ethinyl estradiol. In addition, a summary of the recent literature regarding CAH is presented.
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Affiliation(s)
- Simiao Xu
- Department of Endocrinology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, P.R. China
| | - Shuhong Hu
- Department of Endocrinology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, P.R. China
| | - Xuefeng Yu
- Department of Endocrinology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, P.R. China
| | - Muxun Zhang
- Department of Endocrinology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, P.R. China
| | - Yan Yang
- Department of Endocrinology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, P.R. China
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Oskarsson A, Ullerås E, Ohlsson Andersson Å. Acetaminophen Increases Aldosterone Secretion While Suppressing Cortisol and Androgens: A Possible Link to Increased Risk of Hypertension. Am J Hypertens 2016; 29:1158-64. [PMID: 27217499 DOI: 10.1093/ajh/hpw055] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Accepted: 05/09/2016] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Acetaminophen (paracetamol) is a widely used analgesic and antipyretic drug. Potential side effects are of public health concern, and liver toxicity from acute overdose is well known. More recently, a regular use of acetaminophen has been associated with an increased risk of hypertension. METHODS We investigated effects of acetaminophen on steroidogenesis as a possible mechanism for the hypertensive action by using the human adrenocortical cell line, H295R. Cells were treated with 0.1, 0.5, and 1mM of acetaminophen for 24 hours, and secretion of steroids and gene expression of key steps in the steroidogenesis were investigated. RESULTS Progesterone and aldosterone secretion were increased dose dependently, while secretion of 17α-OH-progesterone and cortisol as well as dehydroepiandrosterone and androstenedione was decreased. CYP17α-hydroxylase activity, assessed by the ratio 17α-OH-progesterone/progesterone, and CYP17-lyase activity, assessed by the ratio androstenedione/17α-OH-progesterone, were both dose-dependently decreased by acetaminophen. No effects were revealed on cell viability. Treatment of cells with 0.5mM of acetaminophen did not cause any effects on the expression of 10 genes in the steroidogenic pathways. CONCLUSIONS The pattern of steroid secretion caused by acetaminophen can be explained by inhibition of CYP17A1 enzyme activity. A decreased secretion of glucocorticoids and androgens, as demonstrated by acetaminophen, would, in an in vivo situation, induce adrenocorticotropic hormone release via negative feedback in the hypothalamic-pituitary-adrenal axis and result in an upregulation of aldosterone secretion. Our results suggest a novel possible mechanism for acetaminophen-induced hypertension, which needs to be further elucidated in clinical investigations.
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Affiliation(s)
- Agneta Oskarsson
- Department of Biomedical Sciences and Veterinary Public Health, Swedish University of Agricultural Sciences, Uppsala, Sweden;
| | - Erik Ullerås
- Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden
| | - Åsa Ohlsson Andersson
- Department of Biomedical Sciences and Veterinary Public Health, Swedish University of Agricultural Sciences, Uppsala, Sweden
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Manenda MS, Hamel CJ, Masselot-Joubert L, Picard MÈ, Shi R. Androgen-metabolizing enzymes: A structural perspective. J Steroid Biochem Mol Biol 2016; 161:54-72. [PMID: 26924584 DOI: 10.1016/j.jsbmb.2016.02.021] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2015] [Revised: 02/15/2016] [Accepted: 02/21/2016] [Indexed: 11/18/2022]
Abstract
Androgen-metabolizing enzymes convert cholesterol, a relatively inert molecule, into some of the most potent chemical messengers in vertebrates. This conversion involves thermodynamically challenging reactions catalyzed by P450 enzymes and redox reactions catalyzed by Aldo-Keto Reductases (AKRs). This review covers the structures of these enzymes with a focus on active site interactions and proposed mechanisms. Due to their role in a number of diseases, particularly in cancer, androgen-metabolizing enzymes have been targets of drug design. Hence we will also highlight how existing knowledge of structure is being used to this end.
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Affiliation(s)
- Mahder Seifu Manenda
- Département de Biochimie, de Microbiologie et de Bio-informatique, PROTEO, Université Laval, Québec City, QC G1V 0A6, Canada; Institut de Biologie Intégrative et des Systèmes (IBIS), Université Laval, Pavillon Charles-Eugène-Marchand, Québec City, QC G1V 0A6, Canada
| | - Charles Jérémie Hamel
- Département de Biochimie, de Microbiologie et de Bio-informatique, PROTEO, Université Laval, Québec City, QC G1V 0A6, Canada; Institut de Biologie Intégrative et des Systèmes (IBIS), Université Laval, Pavillon Charles-Eugène-Marchand, Québec City, QC G1V 0A6, Canada
| | - Loreleï Masselot-Joubert
- Département de Biochimie, de Microbiologie et de Bio-informatique, PROTEO, Université Laval, Québec City, QC G1V 0A6, Canada; Institut de Biologie Intégrative et des Systèmes (IBIS), Université Laval, Pavillon Charles-Eugène-Marchand, Québec City, QC G1V 0A6, Canada
| | - Marie-Ève Picard
- Département de Biochimie, de Microbiologie et de Bio-informatique, PROTEO, Université Laval, Québec City, QC G1V 0A6, Canada; Institut de Biologie Intégrative et des Systèmes (IBIS), Université Laval, Pavillon Charles-Eugène-Marchand, Québec City, QC G1V 0A6, Canada
| | - Rong Shi
- Département de Biochimie, de Microbiologie et de Bio-informatique, PROTEO, Université Laval, Québec City, QC G1V 0A6, Canada; Institut de Biologie Intégrative et des Systèmes (IBIS), Université Laval, Pavillon Charles-Eugène-Marchand, Québec City, QC G1V 0A6, Canada.
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Dent MP, Carmichael PL, Jones KC, Martin FL. Towards a non-animal risk assessment for anti-androgenic effects in humans. ENVIRONMENT INTERNATIONAL 2015; 83:94-106. [PMID: 26115536 DOI: 10.1016/j.envint.2015.06.009] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/17/2015] [Revised: 06/11/2015] [Accepted: 06/12/2015] [Indexed: 06/04/2023]
Abstract
Toxicology testing is undergoing a transformation from a system based on high-dose studies in laboratory animals to one founded primarily on in vitro methods that evaluate changes in normal cellular signalling pathways using human-relevant cells or tissues. We review the tools and approaches that could be used to develop a non-animal safety assessment for anti-androgenic effects in humans, with a focus on the molecular initiating events (MIEs) that human disorders indicate critical for normal functioning of the hypothalamus-pituitary-testicular (HPT) axis. In vitro test systems exist which can be used to characterize the effects of test chemicals on some MIEs such as androgen receptor antagonism, inhibition of steroidogenic enzymes or 5α-reductase inhibition. When used alongside information describing the pharmacokinetics of a specific chemical exposure, these could be used to inform a pathways-based safety assessment. However, some parts of the HPT axis such as events occurring in the hypothalamus or pituitary are not well represented by accepted in vitro methods. In vitro tools to characterize perturbations in these events need to be developed before a fully integrated model of the HPT axis can be described. Knowledge gaps also exist which prevent us from using in vitro data to predict the type and severity of in vivo effect(s) that could arise from a given level of in vitro anti-androgenic activity. This means that more work is needed to reliably link an MIE with an adverse outcome. However, especially for chemicals with low anti-androgenic activity, human exposure data can be used to put in vitro mode of action data into context for risk-based safety decision-making.
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Affiliation(s)
- Matthew P Dent
- Safety and Environmental Assurance Centre, Unilever Colworth Science Park, Bedfordshire MK44 1LQ, UK.
| | - Paul L Carmichael
- Safety and Environmental Assurance Centre, Unilever Colworth Science Park, Bedfordshire MK44 1LQ, UK
| | - Kevin C Jones
- Lancaster Environment Centre, Lancaster University, Bailrigg, Lancaster LA1 4YQ, UK
| | - Francis L Martin
- Lancaster Environment Centre, Lancaster University, Bailrigg, Lancaster LA1 4YQ, UK.
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Lee SJ, Song JE, Hwang S, Lee JY, Park HS, Han S, Rhee Y. Untreated Congenital Adrenal Hyperplasia with 17-α Hydroxylase/17,20-Lyase Deficiency Presenting as Massive Adrenocortical Tumor. Endocrinol Metab (Seoul) 2015; 30:408-13. [PMID: 26248854 PMCID: PMC4595368 DOI: 10.3803/enm.2015.30.3.408] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2014] [Revised: 02/03/2015] [Accepted: 02/27/2015] [Indexed: 11/11/2022] Open
Abstract
Congenital adrenal hyperplasia (CAH) with 17α-hydroxylase/17,20-lyase deficiency is usually characterized by hypertension and primary amenorrhea, sexual infantilism in women, and pseudohermaphroditism in men. hypertension, and sexual infantilism in women and pseudohermaphroditism in men. In rare cases, a huge adrenal gland tumor can present as a clinical manifestation in untreated CAH. Adrenal cortical adenoma is an even more rare phenotype in CAH with 17α-hydroxylase/17,20-lyase deficiency. A 36-year-old female presented with hypertension and abdominal pain caused by a huge adrenal mass. Due to mass size and symptoms, left adrenalectomy was performed. After adrenalectomy, blood pressure remained high. Based on hormonal and genetic evaluation, the patient was diagnosed as CAH with 17α-hydroxylase/17,20-lyase deficiency. The possibility of a tumorous change in the adrenal gland due to untreated CAH should be considered. It is important that untreated CAH not be misdiagnosed as primary adrenal tumor as these conditions require different treatments. Adequate suppression of adrenocorticotropic hormone (ACTH) in CAH is also important to treat and to prevent the tumorous changes in the adrenal gland. Herein, we report a case of untreated CAH with 17α-hydroxylase/17,20-lyase deficiency presenting with large adrenal cortical adenoma and discuss the progression of adrenal gland hyperplasia due to inappropriate suppression of ACTH secretion.
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Affiliation(s)
- Su Jin Lee
- Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Je Eun Song
- Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Sena Hwang
- Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Ji Yeon Lee
- Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Hye Sun Park
- Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Seunghee Han
- Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Yumie Rhee
- Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.
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Kim SM, Rhee JH. A case of 17 alpha-hydroxylase deficiency. Clin Exp Reprod Med 2015; 42:72-6. [PMID: 26161337 PMCID: PMC4496435 DOI: 10.5653/cerm.2015.42.2.72] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2015] [Revised: 06/08/2015] [Accepted: 06/10/2015] [Indexed: 02/06/2023] Open
Abstract
17α-hydroxylase and 17,20-lyase are enzymes encoded by the CYP17A1 gene and are required for the synthesis of sex steroids and cortisol. In 17α-hydroxylase deficiency, there are low blood levels of estrogens, androgens, and cortisol, and resultant compensatory increases in adrenocorticotrophic hormone that stimulate the production of 11-deoxycorticosterone and corticosterone. In turn, the excessive levels of mineralocorticoids lead to volume expansion and hypertension. Females with 17α-hydroxylase deficiency are characterized by primary amenorrhea and delayed puberty, with accompanying hypertension. Affected males usually have female external genitalia, a blind vagina, and intra-abdominal testes. The treatment of this disorder is centered on glucocorticoid and sex steroid replacement. In patients with 17α-hydroxylase deficiency who are being raised as females, estrogen should be supplemented, while genetically female patients with a uterus should also receive progesterone supplementation. Here, we report a case of a 21-year-old female with 17α-hydroxylase deficiency who had received inadequate treatment for a prolonged period of time. We also include a brief review of the recent literature on this disorder.
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Affiliation(s)
| | - Jeong Ho Rhee
- Department of Obstetrics and Gynecology, Keimyung University College of Medicine, Daegu, Korea
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