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Cheng T, Liu J, Sun W, Song G, Ma H. Congenital adrenal hyperplasia with homozygous and heterozygous mutations: a rare family case report. BMC Endocr Disord 2022; 22:57. [PMID: 35255871 PMCID: PMC8900299 DOI: 10.1186/s12902-022-00969-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2021] [Accepted: 02/23/2022] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Congenital adrenal hyperplasia (CAH), characterized by defective adrenal steroidogenesis, is transmitted in an autosomal recessive manner. Mutations in the steroid 21-hydroxylase gene CYP21A2 causing steroid 21-hydroxylase deficiency account for most cases of CAH. The c.145l-1452delGGinsC gene mutation is rare, and only one case has been reported, but the form of gene mutation is different from this case, resulting in different clinical phenotype. The most common pathogenic genotype of CAH is a homozygous or compound heterozygous mutation, but CAH patients homozygous for the p.I173N mutation and heterozygous for the c.1451-1452delGGinsC mutation have not been reported previously. We report herein a familial case of CAH, in which both siblings carry the rare homozygous p.I173N mutation and heterozygous c.1451-1452delGGinsC mutation. CASE PRESENTATION The proband showed amenorrhea, infertility, polycystic ovaries, and increased levels of androgen, rather than the typical clinical manifestations of CAH such as an adrenal crisis or masculine vulva, so was misdiagnosed with polycystic ovary syndrome for many years. Following a correct diagnosis of CAH, she was given glucocorticoid treatment, her menstruation became more regular, and she became pregnant and delivered a healthy baby girl. CONCLUSIONS The genotypes may be p.I173N homozygous or p.I173N/c.1451-1452delGGinsC heterozygous, both mutations could be pathogenic. This complex combination of mutations has not been reported or studied before. Through the report and analysis of this genotype, the content of CAH gene bank is enriched and the misdiagnosis rate of CAH is reduced.
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Affiliation(s)
- Tiantian Cheng
- Department of Internal Medicine, School of Clinical Medicine, North China University of Science and Technology, Tangshan, 063210, Hebei, China
- Department of Endocrinology and Metabolic Diseases, Hebei General Hospital, Shijiazhuang, 050051, Hebei, China
| | - Jing Liu
- Department of Endocrinology and Metabolic Diseases, Hebei General Hospital, Shijiazhuang, 050051, Hebei, China
| | - Wenwen Sun
- Department of Internal Medicine, School of Clinical Medicine, North China University of Science and Technology, Tangshan, 063210, Hebei, China
- Department of Endocrinology and Metabolic Diseases, Hebei General Hospital, Shijiazhuang, 050051, Hebei, China
| | - Guangyao Song
- Department of Endocrinology and Metabolic Diseases, Hebei General Hospital, Shijiazhuang, 050051, Hebei, China
- Hebei Key Laboratory of Metabolic Diseases, Hebei General Hospital, Shijiazhuang, 050051, Hebei, China
| | - Huijuan Ma
- Department of Internal Medicine, School of Clinical Medicine, North China University of Science and Technology, Tangshan, 063210, Hebei, China.
- Department of Endocrinology and Metabolic Diseases, Hebei General Hospital, Shijiazhuang, 050051, Hebei, China.
- Hebei Key Laboratory of Metabolic Diseases, Hebei General Hospital, Shijiazhuang, 050051, Hebei, China.
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