1
|
Disorder of Sex Development Due to 17-Beta-Hydroxysteroid Dehydrogenase Type 3 Deficiency: A Case Report and Review of 70 Different HSD17B3 Mutations Reported in 239 Patients. Int J Mol Sci 2022; 23:ijms231710026. [PMID: 36077423 PMCID: PMC9456484 DOI: 10.3390/ijms231710026] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Revised: 08/09/2022] [Accepted: 08/30/2022] [Indexed: 11/17/2022] Open
Abstract
The 17-beta-hydroxysteroid dehydrogenase type 3 (17-β-HSD3) enzyme converts androstenedione to testosterone and is encoded by the HSD17B3 gene. Homozygous or compound heterozygous HSD17B3 mutations block the synthesis of testosterone in the fetal testis, resulting in a Disorder of Sex Development (DSD). We describe a child raised as a female in whom the discovery of testes in the inguinal canals led to a genetic study by whole exome sequencing (WES) and to the identification of a compound heterozygous mutation of the HSD17B3 gene (c.608C>T, p.Ala203Val, and c.645A>T, p.Glu215Asp). Furthermore, we review all HSD17B3 mutations published so far in cases of 17-β-HSD3 deficiency. A total of 70 different HSD17B3 mutations have so far been reported in 239 patients from 187 families. A total of 118 families had homozygous mutations, 63 had compound heterozygous mutations and six had undetermined genotypes. Mutations occurred in all 11 exons and were missense (55%), splice-site (29%), small deletions and insertions (7%), nonsense (5%), and multiple exon deletions and duplications (2%). Several mutations were recurrent and missense mutations at codon 80 and the splice-site mutation c.277+4A>T each represented 17% of all mutated alleles. These findings may be useful to those involved in the clinical management and genetic diagnosis of this disorder.
Collapse
|
2
|
Yu B, Liu Z, Mao J, Wang X, Zheng J, Xiong S, Cui M, Ma W, Huang Q, Xu H, Huang B, Nie M, Wu X. Novel mutations of HSD17B3 in three Chinese patients with 46,XY Disorders of Sex Development. Steroids 2017; 126:1-6. [PMID: 28774765 DOI: 10.1016/j.steroids.2017.07.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2017] [Revised: 07/03/2017] [Accepted: 07/26/2017] [Indexed: 11/16/2022]
Abstract
17β-Hydroxysteroid dehydrogenase type 3 (17β-HSD3) converts the inactive Δ4-androstenedione (A) to testosterone (T). Its deficiency is the most common testosterone biosynthesis defect that results in 46,XY Disorders Of Sex Development (DSD). However, the disease is difficult to distinguish from other 46,XY DSD for similar clinical phenotypes. Therefore, genetic testing provides good criteria for the diagnosis of the disease. In this study, HSD17B3 gene was examined in 3 unrelated Chinese patients with 46,XY DSD. Direct sequencing and quantitative PCR of HSD17B3 gene revealed the presence of a compound heterozygous mutation (p.I60T/exon1 deletion) in Patient 1, a homozygous (p.I60T) mutation in Patient 2 and a frameshift mutation (p.V25Efs∗54) and an exon1 deletion in Patient 3. All of the mutations have not been reported previously. These novel mutations may expand the mutation database of HSD17B3 gene and provide us new insights into the molecular mechanism of 17β-HSD3 deficiency. It is noteworthy that when direct sequence analysis showed a rare homozygous mutation in patients with non-consanguineous parents, "apparent homozygosity" should be taken into an account and the intragenic deletion should be screened. In addition, when single mutation was found in patients with disease in recessive heredity mode, the intragenic deletion should also be screened.
Collapse
Affiliation(s)
- Bingqing Yu
- Department of Endocrinology, Peking Union Medical College Hospital, Key Laboratory of Endocrinology, National Health and Family Planning Commission of People's Republic of China, Beijing, China
| | - Zhaoxiang Liu
- Department of Endocrinology, Peking Union Medical College Hospital, Key Laboratory of Endocrinology, National Health and Family Planning Commission of People's Republic of China, Beijing, China
| | - Jiangfeng Mao
- Department of Endocrinology, Peking Union Medical College Hospital, Key Laboratory of Endocrinology, National Health and Family Planning Commission of People's Republic of China, Beijing, China
| | - Xi Wang
- Department of Endocrinology, Peking Union Medical College Hospital, Key Laboratory of Endocrinology, National Health and Family Planning Commission of People's Republic of China, Beijing, China
| | - Junjie Zheng
- Department of Endocrinology, Peking Union Medical College Hospital, Key Laboratory of Endocrinology, National Health and Family Planning Commission of People's Republic of China, Beijing, China
| | - Shuyu Xiong
- Department of Endocrinology, Peking Union Medical College Hospital, Key Laboratory of Endocrinology, National Health and Family Planning Commission of People's Republic of China, Beijing, China
| | - Mingxuan Cui
- Department of Endocrinology, Peking Union Medical College Hospital, Key Laboratory of Endocrinology, National Health and Family Planning Commission of People's Republic of China, Beijing, China
| | - Wanlu Ma
- Department of Endocrinology, Peking Union Medical College Hospital, Key Laboratory of Endocrinology, National Health and Family Planning Commission of People's Republic of China, Beijing, China
| | - Qibin Huang
- Department of Endocrinology, Peking Union Medical College Hospital, Key Laboratory of Endocrinology, National Health and Family Planning Commission of People's Republic of China, Beijing, China
| | - Hongli Xu
- Department of Endocrinology, Peking Union Medical College Hospital, Key Laboratory of Endocrinology, National Health and Family Planning Commission of People's Republic of China, Beijing, China
| | - Bingkun Huang
- Department of Endocrinology, Peking Union Medical College Hospital, Key Laboratory of Endocrinology, National Health and Family Planning Commission of People's Republic of China, Beijing, China
| | - Min Nie
- Department of Endocrinology, Peking Union Medical College Hospital, Key Laboratory of Endocrinology, National Health and Family Planning Commission of People's Republic of China, Beijing, China.
| | - Xueyan Wu
- Department of Endocrinology, Peking Union Medical College Hospital, Key Laboratory of Endocrinology, National Health and Family Planning Commission of People's Republic of China, Beijing, China.
| |
Collapse
|
3
|
Ben Rhouma B, Kallabi F, Mahfoudh N, Ben Mahmoud A, Engeli RT, Kamoun H, Keskes L, Odermatt A, Belguith N. Novel cases of Tunisian patients with mutations in the gene encoding 17β-hydroxysteroid dehydrogenase type 3 and a founder effect. J Steroid Biochem Mol Biol 2017; 165:86-94. [PMID: 26956191 DOI: 10.1016/j.jsbmb.2016.03.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2015] [Revised: 02/13/2016] [Accepted: 03/03/2016] [Indexed: 11/17/2022]
Abstract
17β-Hydroxysteroid dehydrogenase type 3 (17β-HSD3) is expressed almost exclusively in the testis and converts Δ4-androstene-3,17-dione to testosterone. Mutations in the HSD17B3 gene causing 17β-HSD3 deficiency are responsible for a rare recessive form of 46, XY Disorders of Sex Development (46, XY DSD). We report novel cases of Tunisian patients with 17β-HSD3 deficiency due to previously reported mutations, i.e. p.C206X and p.G133R, as well as a case with the novel compound heterozygous mutations p.C206X and p.Q176P. Moreover, the previously reported polymorphism p.G289S was identified in a heterozygous state in combination with a novel non-coding variant c.54G>T, also in a heterozygous state, in a male patient presenting with micropenis and low testosterone levels. The identification of four different mutations in a cohort of eight patients confirms the generally observed genetic heterogeneity of 17β-HSD3 deficiency. Nevertheless, analysis of DNA from 272 randomly selected healthy controls from the same geographic area (region of Sfax) revealed a high carrier frequency for the p.C206X mutation of approximately 1 in 40. Genotype reconstruction of the affected pedigree members revealed that all p.C206X mutation carriers harbored the same haplotype, indicating inheritance of the mutation from a common ancestor. Thus, the identification of a founder effect and the elevated carrier frequency of the p.C206X mutation emphasize the importance to consider this mutation in the diagnosis and genetic counseling of affected 17β-HSD3 deficiency pedigrees in Tunisia.
Collapse
Affiliation(s)
- Bochra Ben Rhouma
- Human Molecular Genetic Laboratory, Faculty of Medicine of Sfax, 3030, University of Sfax, Tunisia.
| | - Fakhri Kallabi
- Human Molecular Genetic Laboratory, Faculty of Medicine of Sfax, 3030, University of Sfax, Tunisia
| | - Nadia Mahfoudh
- Department of Immunology, Hedi Chaker Hospital, 3029 Sfax, Tunisia
| | - Afif Ben Mahmoud
- Human Molecular Genetic Laboratory, Faculty of Medicine of Sfax, 3030, University of Sfax, Tunisia
| | - Roger T Engeli
- Division of Molecular and Systems Toxicology, Department of Pharmaceutical Sciences, Pharmacenter, University of Basel, Basel, Switzerland
| | - Hassen Kamoun
- Department of Medical Genetics, Hedi Chaker Hospital, 3029 Sfax, Tunisia
| | - Leila Keskes
- Human Molecular Genetic Laboratory, Faculty of Medicine of Sfax, 3030, University of Sfax, Tunisia
| | - Alex Odermatt
- Division of Molecular and Systems Toxicology, Department of Pharmaceutical Sciences, Pharmacenter, University of Basel, Basel, Switzerland.
| | - Neila Belguith
- Human Molecular Genetic Laboratory, Faculty of Medicine of Sfax, 3030, University of Sfax, Tunisia; Department of Medical Genetics, Hedi Chaker Hospital, 3029 Sfax, Tunisia
| |
Collapse
|
4
|
Mendonca BB, Gomes NL, Costa EMF, Inacio M, Martin RM, Nishi MY, Carvalho FM, Tibor FD, Domenice S. 46,XY disorder of sex development (DSD) due to 17β-hydroxysteroid dehydrogenase type 3 deficiency. J Steroid Biochem Mol Biol 2017; 165:79-85. [PMID: 27163392 DOI: 10.1016/j.jsbmb.2016.05.002] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2016] [Revised: 05/04/2016] [Accepted: 05/05/2016] [Indexed: 12/14/2022]
Abstract
17β-hydroxysteroid dehydrogenase 3 deficiency consists of a defect in the last phase of steroidogenesis, in which androstenedione is converted into testosterone and estrone into estradiol. External genitalia range from female-like to atypical genitalia and most affected males are raised as females. Virilization in subjects with 17β-HSD3 deficiency occurs at the time of puberty and several of them change to male social sex. In male social sex patients, testes can be safely maintained, as long as they are positioned inside the scrotum The phenotype of 46,XY DSD due to 17β-HSD3 deficiency is extremely variable and clinically indistinguishable from other causes of 46,XY DSD such as partial androgen insensitivity syndrome and 5α-reductase 2 deficiency. Laboratory diagnosis is based on a low testosterone/androstenedione ratio due to high serum levels of androstenedione and low levels of testosterone. The disorder is caused by a homozygous or compound heterozygous mutations in the HSD17B3 gene that encodes the 17β-HSD3 isoenzyme leading to an impairment of the conversion of 17-keto into 17-hydroxysteroids. Molecular genetic testing confirms the diagnosis and provides the orientation for genetic counseling. Our proposal in this article is to review the previously reported cases of 17β-HSD3 deficiency adding our own cases.
Collapse
Affiliation(s)
- Berenice B Mendonca
- Developmental Endocrinology Unit, Hormone and Molecular Genetics Laboratory (LIM/42), Endocrinology Division, Internal Medicine Department, Medical School, University of São Paulo, Brazil.
| | - Nathalia Lisboa Gomes
- Developmental Endocrinology Unit, Hormone and Molecular Genetics Laboratory (LIM/42), Endocrinology Division, Internal Medicine Department, Medical School, University of São Paulo, Brazil
| | - Elaine M F Costa
- Developmental Endocrinology Unit, Hormone and Molecular Genetics Laboratory (LIM/42), Endocrinology Division, Internal Medicine Department, Medical School, University of São Paulo, Brazil
| | - Marlene Inacio
- Developmental Endocrinology Unit, Hormone and Molecular Genetics Laboratory (LIM/42), Endocrinology Division, Internal Medicine Department, Medical School, University of São Paulo, Brazil
| | - Regina M Martin
- Developmental Endocrinology Unit, Hormone and Molecular Genetics Laboratory (LIM/42), Endocrinology Division, Internal Medicine Department, Medical School, University of São Paulo, Brazil
| | - Mirian Y Nishi
- Developmental Endocrinology Unit, Hormone and Molecular Genetics Laboratory (LIM/42), Endocrinology Division, Internal Medicine Department, Medical School, University of São Paulo, Brazil
| | | | - Francisco Denes Tibor
- Urology Division, Surgery Department, Medical School, University of São Paulo, Brazil
| | - Sorahia Domenice
- Developmental Endocrinology Unit, Hormone and Molecular Genetics Laboratory (LIM/42), Endocrinology Division, Internal Medicine Department, Medical School, University of São Paulo, Brazil
| |
Collapse
|
5
|
Khorashad BS, Aghili Z, Kreukels BP, Hiradfar M, Roshan GM, Afkhamizadeh M, Abbaszadegan MR, Ghaemi N, Khazai B, Cohen-Kettenis P. Psychosexual Outcome Among Iranian Individuals With 5α-Reductase Deficiency Type 2 and Its Relationship With Parental Sexism. J Sex Med 2016; 13:1629-1641. [DOI: 10.1016/j.jsxm.2016.09.011] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2016] [Revised: 08/26/2016] [Accepted: 09/05/2016] [Indexed: 01/22/2023]
|
6
|
Hassan HA, Mazen I, Gad YZ, Ali OS, Mekkawy M, Essawi ML. Mutational Profile of 10 Afflicted Egyptian Families with 17-β-HSD-3 Deficiency. Sex Dev 2016; 10:66-73. [DOI: 10.1159/000445311] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2016] [Indexed: 11/19/2022] Open
|
7
|
Al-Sinani A, Mula-Abed WAS, Al-Kindi M, Al-Kusaibi G, Al-Azkawi H, Nahavandi N. A Novel Mutation Causing 17-β-Hydroxysteroid Dehydrogenase Type 3 Deficiency in an Omani Child: First Case Report and Review of Literature. Oman Med J 2015; 30:129-34. [PMID: 25960839 DOI: 10.5001/omj.2015.27] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2014] [Accepted: 12/25/2014] [Indexed: 11/03/2022] Open
Abstract
This is the first case report in Oman and the Gulf region of a 17-β-hydroxysteroid dehydrogenase type 3 (17-β-HSD3) deficiency with a novel mutation in the HSD17B3 gene that has not been previously described in the medical literature. An Omani child was diagnosed with 17-β-HSD3 deficiency and was followed up for 11 years at the Pediatric Endocrinology Clinic, Royal Hospital, Oman. He presented at the age of six weeks with ambiguous genitalia, stretched penile and bilateral undescended testes. Ultrasound showed no evidence of any uterine or ovarian structures with oval shaped solid structures in both inguinal regions that were confirmed by histology to be testicular tissues with immature seminiferous tubules only. The diagnosis was made by demonstrating low serum testosterone and high androstenedione, estrone, and androstenedione:testosterone ratio. Karyotyping confirmed 46,XY and the infant was raised as male. Testosterone injections (25mg once monthly) were given at two and six months and then three months before his surgeries at five and seven years of age when he underwent multiple operations for orchidopexy and hypospadias correction. At the age of 10 years he developed bilateral gynecomastia (stage 4). Laboratory investigations showed raised follicle-stimulating hormone, luteinizing hormone, androstenedione, and estrone with low-normal testosterone and low androstendiol glucurunide. Testosterone injections (50mg once monthly for six months) were given that resulted in significant reduction in his gynecomastia. Molecular analysis revealed a previously unreported homozygous variant in exon eight of the HSD17B3 gene (NM_000197.1:c.576G>A.Trp192*). This variant creates a premature stop codon, which is very likely to result in a truncated protein or loss of protein production. This is the first report in the medical literature of this novel HSD17B3 gene mutation. A literature review was conducted to identify the previous studies related to this disorder.
Collapse
Affiliation(s)
- Aisha Al-Sinani
- National Diabetes and Endocrine Centre, Royal Hospital, Muscat, Oman
| | | | - Manal Al-Kindi
- Department of Chemical Pathology, Royal Hospital, Muscat, Oman
| | | | - Hanan Al-Azkawi
- National Diabetes and Endocrine Centre, Royal Hospital, Muscat, Oman
| | | |
Collapse
|