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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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46,XY Disorder of Sex Development Caused by 17 α-Hydroxylase/17,20-Lyase Deficiency due to Homozygous Mutation of CYP17A1 Gene: Consequences of Late Diagnosis. Case Rep Endocrinol 2018; 2018:2086861. [PMID: 29854486 PMCID: PMC5941809 DOI: 10.1155/2018/2086861] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2017] [Revised: 02/23/2018] [Accepted: 03/14/2018] [Indexed: 01/20/2023] Open
Abstract
Context Congenital adrenal hyperplasia (CAH) is an autosomal recessive disease due to specific enzyme deficiencies in the adrenal steroidogenesis pathway. Case Description A 40-year-old Chinese woman was referred to the Endocrine Unit for the work-up of a syndrome characterized by long-lasting and multidrug resistant high blood pressure, severe hypokalemia with metabolic alkalosis, and primary amenorrhea. The patient presented with sexual infantilism, lack of breast development, absence of axillary and pubic hair, tall stature, and slenderness. CT scan revealed enlarged adrenal glands bilaterally and the absence of the uterus, the ovaries, and the Fallopian tubes. Furthermore, diffuse osteopenia and osteoporosis and incomplete ossification of the growth plate cartilages were demonstrated. Chromosomal analysis showed a normal male 46,XY, karyotype, and on molecular analysis of the CYP17A1 gene she resulted homozygous for the g.4869T>A; g.4871delC (p.Y329Kfs?) mutation in exon 6. Hydrocortisone and ethinyl-estradiol supplementation therapy led to incomplete withdrawal of antihypertensive drug and breast development progression to Tanner stage B2 and slight height increase, respectively. Conclusions We describe a late-discovered case of CAH with 46,XY disorder of sex development. Deficiency of 17α-hydroxylase/17,20-lyase due to a homozygous CYP17A1 gene mutation was the underlying cause. Laboratory, imaging, and genetic features are herein reported and discussed.
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