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Rawat A, Karotkar S, Lakra M, Reddy R, Meshram R, Taksande A. A Novel Steroidogenic Acute Regulatory Protein (StAR) Mutation Causing Adrenal Insufficiency in a Neonate: A Case Report of a Rare Medical Condition. Cureus 2024; 16:e66080. [PMID: 39229408 PMCID: PMC11368709 DOI: 10.7759/cureus.66080] [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: 07/06/2024] [Accepted: 08/03/2024] [Indexed: 09/05/2024] Open
Abstract
Congenital lipoid adrenal hyperplasia is a very rare and severe cause of adrenal insufficiency. It occurs due to a mutation of the steroidogenic acute regulatory protein (StAR), disrupting adrenal steroid biosynthesis. Here, we report a case of a three-week-old female infant with vomiting, failure to thrive, electrolyte imbalance, and generalized hyperpigmentation. The hormonal assay and genetic diagnosis confirmed a mutation in the StAR protein, leading to adrenal insufficiency. Appropriate replacement therapy resulted in the resolution of clinical and biochemical abnormalities. This case is being reported for its rare etiology and diagnostic clues. It can guide clinicians to keep adrenal insufficiency as a differential diagnosis in a neonate presenting with hyperpigmentation and electrolyte disturbance to save lives.
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Affiliation(s)
- Aditi Rawat
- Department of Neonatology, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Sagar Karotkar
- Department of Pediatrics, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Mahaveer Lakra
- Department of Pediatrics, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Ravi Reddy
- Department of Neonatology, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Revatdhamma Meshram
- Department of Pediatrics, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Amar Taksande
- Department of Pediatrics, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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2
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Gurpinar Tosun B, Guran T. Rare forms of congenital adrenal hyperplasia. Clin Endocrinol (Oxf) 2023. [PMID: 38126084 DOI: 10.1111/cen.15009] [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: 09/03/2023] [Revised: 11/10/2023] [Accepted: 12/07/2023] [Indexed: 12/23/2023]
Abstract
Congenital adrenal hyperplasia (CAH) is a group of autosomal recessive disorders due to pathogenic variants in genes encoding enzymes and cofactors involved in adrenal steroidogenesis. Although 21-hydroxylase, 11β-hydroxylase, 3β-hydroxysteroid dehydrogenase type 2, 17α-hydroxylase/17,20-lyase, P450 oxidoreductase, steroidogenic acute regulatory protein, cholesterol side-chain cleavage enzyme deficiencies are considered within the definition of CAH, the term 'CAH' is often used to refer to '21-hydroxylase deficiency (21OHD)' since 21OHD accounts for approximately 95% of CAH in most populations. The prevalence of the rare forms of CAH varies according to ethnicity and geographical location. In most cases, the biochemical fingerprint of impaired steroidogenesis points to the specific subtypes of CAH, and genetic testing is usually required to confirm the diagnosis. Despite there are significant variations in clinical characteristics and management, most data about the rare CAH forms are extrapolated from 21OHD. This review article aims to collate the currently available data about the diagnosis and the management of rare forms of CAH.
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Affiliation(s)
- Busra Gurpinar Tosun
- Department of Paediatric Endocrinology and Diabetes, School of Medicine, Marmara University, Istanbul, Turkey
| | - Tulay Guran
- Department of Paediatric Endocrinology and Diabetes, School of Medicine, Marmara University, Istanbul, Turkey
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3
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Miller WL, White PC. History of Adrenal Research: From Ancient Anatomy to Contemporary Molecular Biology. Endocr Rev 2023; 44:70-116. [PMID: 35947694 PMCID: PMC9835964 DOI: 10.1210/endrev/bnac019] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Indexed: 01/20/2023]
Abstract
The adrenal is a small, anatomically unimposing structure that escaped scientific notice until 1564 and whose existence was doubted by many until the 18th century. Adrenal functions were inferred from the adrenal insufficiency syndrome described by Addison and from the obesity and virilization that accompanied many adrenal malignancies, but early physiologists sometimes confused the roles of the cortex and medulla. Medullary epinephrine was the first hormone to be isolated (in 1901), and numerous cortical steroids were isolated between 1930 and 1949. The treatment of arthritis, Addison's disease, and congenital adrenal hyperplasia (CAH) with cortisone in the 1950s revolutionized clinical endocrinology and steroid research. Cases of CAH had been reported in the 19th century, but a defect in 21-hydroxylation in CAH was not identified until 1957. Other forms of CAH, including deficiencies of 3β-hydroxysteroid dehydrogenase, 11β-hydroxylase, and 17α-hydroxylase were defined hormonally in the 1960s. Cytochrome P450 enzymes were described in 1962-1964, and steroid 21-hydroxylation was the first biosynthetic activity associated with a P450. Understanding of the genetic and biochemical bases of these disorders advanced rapidly from 1984 to 2004. The cloning of genes for steroidogenic enzymes and related factors revealed many mutations causing known diseases and facilitated the discovery of new disorders. Genetics and cell biology have replaced steroid chemistry as the key disciplines for understanding and teaching steroidogenesis and its disorders.
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Affiliation(s)
- Walter L Miller
- Department of Pediatrics, Center for Reproductive Sciences, and Institute for Human Genetics, University of California, San Francisco, CA, USA
| | - Perrin C White
- Division of Pediatric Endocrinology, University of Texas Southwestern Medical Center, Dallas, TX, USA
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Subki SH, Wadea Mohammed Hussain R, Al-Agha AE. Congenital lipoid adrenal hyperplasia in a Saudi infant. Endocrinol Diabetes Metab Case Rep 2022; 2022:22-0294. [PMID: 36053179 PMCID: PMC9513656 DOI: 10.1530/edm-22-0294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Accepted: 08/11/2022] [Indexed: 11/08/2022] Open
Abstract
Summary Congenital lipoid adrenal hyperplasia (CLAH) is characterized by a defect in the STAR protein-encoding gene that attenuates all steroidogenesis pathways. Herein, we present the first reported case in Saudi Arabia of a 46 XY, phenotypically female infant with an unfamiliar, darkened complexion compared to the family's skin color. Based on the clinical and biochemical findings, CLAH was diagnosed and glucocorticoid replacement therapy was initiated. As a result, we suggest that pediatricians should always investigate the possibility of adrenal insufficiency when encountering unusual dark skin. Learning points Pediatricians should be prompted to rule out adrenal insufficiency in unexpectedly dark skin neonates. In such patients, pediatricians should not wait until the neonate develops an adrenal crisis. A low level of 17-hydroxyprogesterone does not always rule out the possibility of inherited adrenal gland disorders, and additional tests should be performed for early detection.
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Affiliation(s)
- Siham Hussein Subki
- Pediatrics Department, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | | | - Abdulmoein Eid Al-Agha
- Pediatrics Department, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
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Maharaj A, Kwong R, Williams J, Smith C, Storr H, Krone R, Braslavsky D, Clemente M, Ram N, Banerjee I, Çetinkaya S, Buonocore F, Güran T, Achermann JC, Metherell L, Prasad R. A retrospective analysis of endocrine disease in sphingosine-1-phosphate lyase insufficiency: case series and literature review. Endocr Connect 2022; 11:e220250. [PMID: 35904228 PMCID: PMC9346324 DOI: 10.1530/ec-22-0250] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 06/28/2022] [Indexed: 11/14/2022]
Abstract
Sphingosine-1-phosphate lyase (SGPL1) insufficiency syndrome (SPLIS) is an autosomal recessive multi-system disorder, which mainly incorporates steroid-resistant nephrotic syndrome and primary adrenal insufficiency. Other variable endocrine manifestations are described. In this study, we aimed to comprehensively annotate the endocrinopathies associated with pathogenic SGPL1 variants and assess for genotype-phenotype correlations by retrospectively reviewing the reports of endocrine disease within our patient cohort and all published cases in the wider literature up to February 2022. Glucocorticoid insufficiency in early childhood is the most common endocrine manifestation affecting 64% of the 50 patients reported with SPLIS, and a third of these individuals have additional mineralocorticoid deficiency. While most individuals also have nephrotic syndrome, SGPL1 variants also account for isolated adrenal insufficiency at presentation. Primary gonadal insufficiency, manifesting with microphallus and cryptorchidism, is reported in less than one-third of affected boys, all with concomitant adrenal disease. Mild primary hypothyroidism affects approximately a third of patients. There is paucity of data on the impact of SGPL1 deficiency on growth, and pubertal development, limited by the early and high mortality rate (approximately 50%). There is no clear genotype-phenotype correlation overall in the syndrome, with variable disease penetrance within individual kindreds. However, with regards to endocrine phenotype, the most prevalent disease variant p.R222Q (affecting 22%) is most consistently associated with isolated glucocorticoid deficiency. To conclude, SPLIS is associated with significant multiple endocrine disorders. While endocrinopathy in the syndrome generally presents in infancy, late-onset disease also occurs. Screening for these is therefore warranted both at diagnosis and through follow-up.
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Affiliation(s)
- Avinaash Maharaj
- Centre for Endocrinology, John Vane Science Centre, Queen Mary University of London, London, UK
| | - Ruth Kwong
- Centre for Endocrinology, John Vane Science Centre, Queen Mary University of London, London, UK
| | - Jack Williams
- Centre for Endocrinology, John Vane Science Centre, Queen Mary University of London, London, UK
| | - Christopher Smith
- Centre for Endocrinology, John Vane Science Centre, Queen Mary University of London, London, UK
| | - Helen Storr
- Centre for Endocrinology, John Vane Science Centre, Queen Mary University of London, London, UK
| | - Ruth Krone
- Birmingham Children’s Hospital, Birmingham, UK
| | - Debora Braslavsky
- Centro de Investigaciones Endocrinológicas ‘Dr. Cesar Bergadá’ (CEDIE) – CONICET – FEI – División de Endocrinología, Hospital de Niños ‘Ricardo Gutiérrez’, Buenos Aires, Argentina
| | - Maria Clemente
- Paediatric Endocrinology, Growth and Development Research Unit, Vall d’Hebron Research Institute (VHIR), Hospital Vall d’Hebron, CIBERER, Instituto de Salud Carlos III, Barcelona, Spain
| | - Nanik Ram
- Department of Endocrinology, The Aga Khan University Hospital, Karachi, Pakistan
| | - Indraneel Banerjee
- Department of Paediatric Endocrinology, Royal Manchester Children’s Hospital, Manchester, UK
| | - Semra Çetinkaya
- Health Sciences University, Dr. Sami Ulus Obstetrics and Gynaecology, Children’s Health and Disease Education and Research Hospital, Ankara, Turkey
| | - Federica Buonocore
- Genetics and Genomic Medicine Research and Teaching Department, UCL Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Tülay Güran
- Department of Paediatric Endocrinology and Diabetes, Marmara University, School of Medicine, Istanbul, Turkey
| | - John C Achermann
- Genetics and Genomic Medicine Research and Teaching Department, UCL Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Louise Metherell
- Centre for Endocrinology, John Vane Science Centre, Queen Mary University of London, London, UK
| | - Rathi Prasad
- Centre for Endocrinology, John Vane Science Centre, Queen Mary University of London, London, UK
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Pitsava G, Stratakis CA. Adrenal hyperplasias in childhood: An update. Front Endocrinol (Lausanne) 2022; 13:937793. [PMID: 35992119 PMCID: PMC9382287 DOI: 10.3389/fendo.2022.937793] [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: 05/06/2022] [Accepted: 07/08/2022] [Indexed: 11/13/2022] Open
Abstract
Pediatric adrenocortical hyperplasias are rare; they usually present with Cushing syndrome (CS); of them, isolated micronodular adrenal disease and its variant, primary pigmented adrenocortical disease are the most commonly encountered. Most cases are due to defects in the cyclic AMP/protein kinase A (cAMP/PKA) pathway, although a few cases remain without an identified genetic defect. Another cause of adrenal hyperplasia in childhood is congenital adrenal hyperplasia, a group of autosomal recessive disorders that affect steroidogenic enzymes in the adrenal cortex. Clinical presentation varies and depends on the extent of the underlying enzymatic defect. The most common form is due to 21-hydroxylase deficiency; it accounts for more than 90% of the cases. In this article, we discuss the genetic etiology of adrenal hyperplasias in childhood.
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Affiliation(s)
- Georgia Pitsava
- Division of Intramural Research, Division of Population Health Research, Eunice Kennedy Shriver National Institutes of Child Health and Human Development, National Institutes of Health, Bethesda, MD, United States
- Section on Endocrinology and Genetics, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, United States
- *Correspondence: Georgia Pitsava,
| | - Constantine A. Stratakis
- Section on Endocrinology and Genetics, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, United States
- Human Genetics and Precision Medicine, Institute of Molecular Biology and Biotechnology of the Foundation for Research and Technology Hellas (IMBB-FORTH), Heraklion, Greece
- ELPEN Research Institute, ELPEN, Athens, Greece
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Bry-Gauillard H, Belin F, Vinolas C, Renoult-Pierre P, Massin N, Young J, Sifer C, Grynberg M. Live birth after in-vitro maturation of oocytes in a patient with specific ovarian insufficiency caused by long-term mitotane treatment for adrenocortical carcinoma. Reprod Biomed Online 2021; 44:304-309. [PMID: 34815159 DOI: 10.1016/j.rbmo.2021.10.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 09/14/2021] [Accepted: 10/04/2021] [Indexed: 11/28/2022]
Abstract
RESEARCH QUESTION How should the fertility of a woman with persistent specific ovarian dysfunction after long-term mitotane exposure be managed? DESIGN Case report. A 33-year-old woman who underwent surgery for adrenocortical carcinoma and treated with mitotane was referred for infertility. She rapidly became amenorrhoeic while taking mitotane, a condition that persisted for 5 years after cessation. Repeated serum hormone evaluation showed collapsed androgen levels, low oestradiol, high gonadotrophins (LH 69 and 63; FSH 23 and 43 IU/l), relatively high inhibin B level and slightly decreased anti-Müllerian hormone levels (1.4 and 0.7 ng/ml). An ultrasound scan revealed an antral follicle count of 13, contrasting with high serum gonadotrophin levels. After failure to obtain follicular growth after ovarian stimulation, in-vitro maturation (IVM) of immature oocytes aspirated from the antral follicles was carried out for microinjection with the spermatozoa of the patient's partner. RESULTS Two cycles of unstimulated egg retrieval were carried out, producing seven IVM oocytes, which were microinjected. A total of three cleavage-stage embryos were vitrified and unsuccessfully transferred after endometrial preparation using hormone replacement therapy (HRT). After a 20-month break, two new attempts were carried out under HRT with the aim of achieving a fresh embryo transfer. The last attempt succeeded after transfer of a single day-2 embryo, and the patient delivered a healthy baby. CONCLUSION Persistent specific impaired ovarian function 5 years after withdrawal of mitotane, and the first live birth after IVM in this situation, are reported. The question of fertility preservation before long-term mitotane treatment is raised.
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Affiliation(s)
- Hélène Bry-Gauillard
- Service de Médecine de la Reproduction et Gynécologie Obstétrique Centre Hospitalier Intercommunal de Créteil, 40 Avenue de Verdun 94010 Créteil Cedex.
| | - Florine Belin
- Service de Médecine de la Reproduction et Gynécologie Obstétrique Centre Hospitalier Intercommunal de Créteil, 40 Avenue de Verdun 94010 Créteil Cedex
| | - Claire Vinolas
- Service de Médecine de la Reproduction et Gynécologie Obstétrique Centre Hospitalier Intercommunal de Créteil, 40 Avenue de Verdun 94010 Créteil Cedex
| | - Peggy Renoult-Pierre
- Service de Médecine de la Reproduction et Gynécologie Obstétrique Centre Hospitalier Intercommunal de Créteil, 40 Avenue de Verdun 94010 Créteil Cedex
| | - Nathalie Massin
- Service de Médecine de la Reproduction et Gynécologie Obstétrique Centre Hospitalier Intercommunal de Créteil, 40 Avenue de Verdun 94010 Créteil Cedex
| | - Jacques Young
- Service de Médecine de la Reproduction et Gynécologie Obstétrique Centre Hospitalier Intercommunal de Créteil, 40 Avenue de Verdun 94010 Créteil Cedex
| | - Christophe Sifer
- Service de Médecine de la Reproduction et Gynécologie Obstétrique Centre Hospitalier Intercommunal de Créteil, 40 Avenue de Verdun 94010 Créteil Cedex
| | - Michael Grynberg
- Service de Médecine de la Reproduction et Gynécologie Obstétrique Centre Hospitalier Intercommunal de Créteil, 40 Avenue de Verdun 94010 Créteil Cedex
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Shao S, Zhao H, Lu Z, Lei X, Zhang Y. Circadian Rhythms Within the Female HPG Axis: From Physiology to Etiology. Endocrinology 2021; 162:6298422. [PMID: 34125877 PMCID: PMC8256628 DOI: 10.1210/endocr/bqab117] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2021] [Indexed: 12/12/2022]
Abstract
Declining female fertility has become a global health concern. It results partially from an abnormal circadian clock caused by unhealthy diet and sleep habits in modern life. The circadian clock system is a hierarchical network consisting of central and peripheral clocks. It not only controls the sleep-wake and feeding-fasting cycles but also coordinates and maintains the required reproductive activities in the body. Physiologically, the reproductive processes are governed by the hypothalamic-pituitary-gonadal (HPG) axis in a time-dependent manner. The HPG axis releases hormones, generates female characteristics, and achieves fertility. Conversely, an abnormal daily rhythm caused by aberrant clock genes or abnormal environmental stimuli contributes to disorders of the female reproductive system, such as polycystic ovarian syndrome and premature ovarian insufficiency. Therefore, breaking the "time code" of the female reproductive system is crucial. In this paper, we review the interplay between circadian clocks and the female reproductive system and present its regulatory principles, moving from normal physiology regulation to disease etiology.
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Affiliation(s)
- Shuyi Shao
- Obstetrics and Gynecology Hospital, Fudan University, Shanghai, 200011, China
- The Shanghai Key Laboratory of Female Reproductive Endocrine-Related Diseases, Shanghai, 200011, China
| | - Huanqiang Zhao
- Obstetrics and Gynecology Hospital, Fudan University, Shanghai, 200011, China
- The Shanghai Key Laboratory of Female Reproductive Endocrine-Related Diseases, Shanghai, 200011, China
| | - Zhiying Lu
- Obstetrics and Gynecology Hospital, Fudan University, Shanghai, 200011, China
- The Shanghai Key Laboratory of Female Reproductive Endocrine-Related Diseases, Shanghai, 200011, China
| | - Xiaohong Lei
- Obstetrics and Gynecology Hospital, Fudan University, Shanghai, 200011, China
- The Shanghai Key Laboratory of Female Reproductive Endocrine-Related Diseases, Shanghai, 200011, China
| | - Ying Zhang
- Obstetrics and Gynecology Hospital, Fudan University, Shanghai, 200011, China
- The Shanghai Key Laboratory of Female Reproductive Endocrine-Related Diseases, Shanghai, 200011, China
- Correspondence: Dr. Ying Zhang, Obstetrics and Gynecology Hospital of Fudan University, Fangxie Road 419, Huangpu District, Shanghai, 200011, China.
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Zhang T, Ma X, Wang J, Jia C, Wang W, Dong Z, Ye L, Sun S, Hu R, Ning G, Li C, Lu W. Clinical and molecular characterization of thirty Chinese patients with congenital lipoid adrenal hyperplasia. J Steroid Biochem Mol Biol 2021; 206:105788. [PMID: 33227378 DOI: 10.1016/j.jsbmb.2020.105788] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 11/06/2020] [Accepted: 11/06/2020] [Indexed: 02/02/2023]
Abstract
Congenital lipoid adrenal hyperplasia (LCAH), as the most severe form of congenital adrenal hyperplasia (CAH), is caused by mutations in the steroidogenic acute regulatory protein (STAR). Affected patients were typically characterized by adrenal insufficiency in the first year of life and present with female external genitalia regardless of karyotype. Non-classic LCAH patients usually present from 2 to 4 years old with glucocorticoid deficiency and mild mineralocorticoid deficiency, even develop naturally masculinized external genitalia at birth when they have 46,XY karyotype. We described thirty patients from unrelated Chinese families, including three non-classic LCAH ones. Four novel mutations were reported, including c.556A > G, c.179-15G > T, c.695delG and c.306 + 3_c.306 + 6delAAGT. The c.772C > T is the most common STAR mutation in Chinese population, suggesting a possibility of founder effect. Enzymatic activity assay combined with clinical characteristics showed a good genotype-phenotype correlation in this study. Residual STAR activity more than 20 % may be correlated with non-classic LCAH phenotype. We support the perspective that onset age may be affected by multiple factors and masculinization should be the main weighting factor for diagnosis of non-classic LCAH. Compared with 46,XX LCAH patients, less 46,XY ones were found in our report. A less comprehensive inspection and an easy diagnosis due to classical phenotype both would reduce the possibility of 46,XY LCAH patients to be referred to specialists or geneticists.
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MESH Headings
- Adrenal Hyperplasia, Congenital/epidemiology
- Adrenal Hyperplasia, Congenital/genetics
- Adrenal Hyperplasia, Congenital/pathology
- Adrenal Insufficiency/genetics
- Adrenal Insufficiency/pathology
- Child, Preschool
- China/epidemiology
- Disorder of Sex Development, 46,XY/epidemiology
- Disorder of Sex Development, 46,XY/genetics
- Disorder of Sex Development, 46,XY/pathology
- Female
- Glucocorticoids/deficiency
- Glucocorticoids/genetics
- Humans
- Karyotype
- Male
- Mutation/genetics
- Phenotype
- Phosphoproteins/genetics
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Affiliation(s)
- Tingting Zhang
- Department of Pediatrics, Ruijin Hospital Affiliated to Shanghai Jiao Tong University, Shanghai, 200025, China
| | - Xiaoyu Ma
- Department of Pediatrics, Ruijin Hospital Affiliated to Shanghai Jiao Tong University, Shanghai, 200025, China
| | - Junqi Wang
- Department of Pediatrics, Ruijin Hospital Affiliated to Shanghai Jiao Tong University, Shanghai, 200025, China
| | - Caiwei Jia
- State Key Laboratory of Molecular Biology, Shanghai Institute of Biochemistry and Cell Biology, Center for Excellence in Molecular Cell Science, Chinese Academy of Sciences, Shanghai, 200031, China; University of Chinese Academy of Sciences, Beijing, 100049, China
| | - Wei Wang
- Department of Pediatrics, Ruijin Hospital Affiliated to Shanghai Jiao Tong University, Shanghai, 200025, China
| | - Zhiya Dong
- Department of Pediatrics, Ruijin Hospital Affiliated to Shanghai Jiao Tong University, Shanghai, 200025, China
| | - Lei Ye
- Department of Endocrine and Metabolic Diseases, Shanghai Clinical Center for Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
| | - Shouyue Sun
- Department of Endocrine and Metabolic Diseases, Shanghai Clinical Center for Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
| | - Ronggui Hu
- State Key Laboratory of Molecular Biology, Shanghai Institute of Biochemistry and Cell Biology, Center for Excellence in Molecular Cell Science, Chinese Academy of Sciences, Shanghai, 200031, China; University of Chinese Academy of Sciences, Beijing, 100049, China
| | - Guang Ning
- Department of Endocrine and Metabolic Diseases, Shanghai Clinical Center for Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China.
| | - Chuanyin Li
- State Key Laboratory of Molecular Biology, Shanghai Institute of Biochemistry and Cell Biology, Center for Excellence in Molecular Cell Science, Chinese Academy of Sciences, Shanghai, 200031, China; University of Chinese Academy of Sciences, Beijing, 100049, China.
| | - Wenli Lu
- Department of Pediatrics, Ruijin Hospital Affiliated to Shanghai Jiao Tong University, Shanghai, 200025, China.
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10
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Luo Y, Bai R, Wang Z, Zhu X, Xing J, Li X. STAR mutations causing non‑classical lipoid adrenal hyperplasia manifested as familial glucocorticoid deficiency. Mol Med Rep 2020; 22:681-686. [PMID: 32627004 PMCID: PMC7339677 DOI: 10.3892/mmr.2020.11140] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Accepted: 03/31/2020] [Indexed: 11/27/2022] Open
Abstract
Familial glucocorticoid deficiency (FGD) is a rare autosomal recessive disease characterized by single cortisol deficiency but normal aldosterone and renin levels. Beginning from the discovery of the disease to that of the pathogenic genes over a period of 30 years, the development of gene detection technology has identified a large number of FGD-related genes. Despite the fact that the genetic defect underlying this disease is known for approximately 70% of the patients diagnosed with FGD, there are still several unknown factors causing it. FGD is divided into type 1, type 2 and non-classical type according to the mutant gene. The case described in the present study reported two patients, who were siblings, having skin hyperpigmentation and undergone treatment in adulthood. The gonadal development was normal and the proband had a 10-year-old son. Laboratory tests suggested glucocorticoid deficiency and a mild lack of mineralocorticoid, indicating hyponatremia and hypotension in the proband. In addition, cortisol deficiency was not affected by adrenocorticotropic hormone treatment, while the adrenal glands in the two patients did not show any hyperplasia. Gene analysis revealed two compound heterozygote mutations c.533T>A (p. Leu178Gln) and c.737A>G (p. Asp246Gly) in the steroid hormone acute regulatory protein (STAR) gene in both patients, which may have been obtained from their parents and the proband passed one of the mutations to her son. The present study results revealed that STAR mutations cause non-classic congenital lipoid adrenal hyperplasia in China.
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Affiliation(s)
- Yuanyuan Luo
- Department of Geriatrics, The First People's Hospital of Yunnan Province, The Affiliated Hospital of Kunming University of Science and Technology, Kunming, Yunnan 650032, P.R. China
| | - Ruojing Bai
- Department of Medical Technology, Beijing Health Vocational College, Beijing 100053, P.R. China
| | - Zhifang Wang
- Department of Endocrinology and Metabolism, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan 450052, P.R. China
| | - Xiaofan Zhu
- Department of Genetic and Prenatal Diagnosis Center, Chinese University of Hong Kong, Hong Kong 999077, SAR, P.R. China
| | - Jingjing Xing
- Department of Endocrinology and Metabolism, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan 450052, P.R. China
| | - Xialian Li
- Department of Endocrinology and Metabolism, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan 450052, P.R. China
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11
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Balsamo A, Baronio F, Ortolano R, Menabo S, Baldazzi L, Di Natale V, Vissani S, Cassio A. Congenital Adrenal Hyperplasias Presenting in the Newborn and Young Infant. Front Pediatr 2020; 8:593315. [PMID: 33415088 PMCID: PMC7783414 DOI: 10.3389/fped.2020.593315] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Accepted: 11/23/2020] [Indexed: 12/25/2022] Open
Abstract
Congenital adrenal hyperplasia includes autosomal recessive conditions that affect the adrenal cortex steroidogenic enzymes (cholesterol side-chain cleavage enzyme; 3β-hydroxysteroid dehydrogenase; 17α-hydroxylase/17,20 lyase; P450 oxidoreductase; 21-hydroxylase; and 11β-hydroxylase) and proteins (steroidogenic acute regulatory protein). These are located within the three major pathways of the steroidogenic apparatus involved in the production of mineralocorticoids, glucocorticoids, and androgens. Many countries have introduced newborn screening program (NSP) based on 17-OH-progesterone (17-OHP) immunoassays on dried blood spots, which enable faster diagnosis and treatment of the most severe forms of 21-hydroxylase deficiency (21-OHD). However, in several others, the use of this diagnostic tool has not yet been implemented and clinical diagnosis remains challenging, especially for males. Furthermore, less severe classic forms of 21-OHD and other rarer types of CAHs are not identified by NSP. The aim of this mini review is to highlight both the main clinical characteristics and therapeutic options of these conditions, which may be useful for a differential diagnosis in the neonatal period, while contributing to the biochemical evolution taking place in the steroidogenic field. Currently, chromatographic techniques coupled with tandem mass spectrometry are gaining attention due to an increase in the reliability of the test results of NPS for detecting 21-OHD. Furthermore, the possibility of identifying CAH patients that are not affected by 21-OHD but presenting elevated levels of 17-OHP by NSP and the opportunity to include the recently investigated 11-oxygenated androgens in the steroid profiles are promising tools for a more precise diagnosis and monitoring of some of these conditions.
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Affiliation(s)
- Antonio Balsamo
- Pediatric Endocrinology Unit, Department of Medical and Surgical Sciences, Endo-ERN Centre IT11, S.Orsola-Malpighi University Hospital, Bologna, Italy
| | - Federico Baronio
- Pediatric Endocrinology Unit, Department of Medical and Surgical Sciences, Endo-ERN Centre IT11, S.Orsola-Malpighi University Hospital, Bologna, Italy
| | - Rita Ortolano
- Pediatric Endocrinology Unit, Department of Medical and Surgical Sciences, Endo-ERN Centre IT11, S.Orsola-Malpighi University Hospital, Bologna, Italy
| | - Soara Menabo
- Genetic Unit, Department of Medical and Surgical Sciences, Endo-ERN Centre IT11, S.Orsola-Malpighi University Hospital, Bologna, Italy
| | - Lilia Baldazzi
- Genetic Unit, Department of Medical and Surgical Sciences, Endo-ERN Centre IT11, S.Orsola-Malpighi University Hospital, Bologna, Italy
| | - Valeria Di Natale
- Pediatric Endocrinology Unit, Department of Medical and Surgical Sciences, Endo-ERN Centre IT11, S.Orsola-Malpighi University Hospital, Bologna, Italy
| | - Sofia Vissani
- Pediatric Endocrinology Unit, Department of Medical and Surgical Sciences, Endo-ERN Centre IT11, S.Orsola-Malpighi University Hospital, Bologna, Italy
| | - Alessandra Cassio
- Pediatric Endocrinology Unit, Department of Medical and Surgical Sciences, Endo-ERN Centre IT11, S.Orsola-Malpighi University Hospital, Bologna, Italy
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Wang Y, Wu H, Sun ZS. The biological basis of sexual orientation: How hormonal, genetic, and environmental factors influence to whom we are sexually attracted. Front Neuroendocrinol 2019; 55:100798. [PMID: 31593707 DOI: 10.1016/j.yfrne.2019.100798] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Revised: 09/29/2019] [Accepted: 10/03/2019] [Indexed: 12/11/2022]
Abstract
Humans develop relatively stable attractions to sexual partners during maturation and present a spectrum of sexual orientation from homosexuality to heterosexuality encompassing varying degrees of bisexuality, with some individuals also displaying asexuality. Sexual orientation represents a basic life phenomenon for humans. However, the molecular mechanisms underlying these diverse traits of sexual orientation remain highly controversial. In this review, we systematically discuss recent advancements in sexual orientation research, including those related to measurements and associated brain regions. Current findings regarding sexual orientation modulation by hormonal, genetic, maternal immune system, and environmental factors are summarized in both human and model systems. We also emphasize that future studies should recognize the differences between males and females and pay more attention to minor traits and the epigenetic regulation of sexual orientation. A comprehensive view of sexual orientation may promote our understanding of the biological basis of sex, and that of human reproduction, and evolution.
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Affiliation(s)
- Yan Wang
- Beijing Institutes of Life Science, Chinese Academy of Sciences, Beijing 100101, China
| | - Haoda Wu
- Beijing Institutes of Life Science, Chinese Academy of Sciences, Beijing 100101, China; Sino-Danish College, University of the Chinese Academy of Sciences, Beijing 100190, China
| | - Zhong Sheng Sun
- Beijing Institutes of Life Science, Chinese Academy of Sciences, Beijing 100101, China; Sino-Danish College, University of the Chinese Academy of Sciences, Beijing 100190, China; Institute of Genomic Medicine, Wenzhou Medical University, Wenzhou 325000, China.
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13
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Schteingart HF, Picard JY, Valeri C, Marshall I, Treton D, di Clemente N, Rey RA, Josso N. A mutation inactivating the distal SF1 binding site on the human anti-Müllerian hormone promoter causes persistent Müllerian duct syndrome. Hum Mol Genet 2019; 28:3211-3218. [DOI: 10.1093/hmg/ddz147] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Revised: 06/13/2019] [Accepted: 06/16/2019] [Indexed: 01/10/2023] Open
Abstract
AbstractThe persistent Müllerian duct syndrome (PMDS) is a 46,XY disorder of sexual development characterized by the persistence of Müllerian duct derivatives, uterus and tubes, in otherwise normally masculinized males. The condition, transmitted as a recessive autosomal trait, is usually due to mutations in either the anti-Müllerian hormone (AMH) gene or its main receptor. Many variants of these genes have been described, all targeting the coding sequences. We report the first case of PMDS due to a regulatory mutation. The AMH promoter contains two binding sites for steroidogenic factor 1 (SF1), one at −102 and the other at −228. Our patient carries a single base deletion at −225, significantly decreasing its capacity for binding SF1, as measured by the electrophoresis mobility shift assay. Furthermore, by linking the AMH promoter to the luciferase gene, we show that the transactivation capacity of the promoter is significantly decreased by the mutation, in contrast to the disruption of the −102 binding site. To explain the difference in impact we hypothesize that SF1 could partially overcome the lack of binding to the −102 binding site by interacting with a GATA4 molecule linked to a nearby response element. We show that disruption of both the −102 SF1 and the −84 GATA response elements significantly decreases the transactivation capacity of the promoter. In conclusion, we suggest that the distance between mutated SF1 sites and potentially rescuing GATA binding motifs might play a role in the development of PMDS.
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Affiliation(s)
- Helena F Schteingart
- Centro de Investigaciones Endocrinológicas ‘Dr. César Bergadá’ (CEDIE), CONICET-FEI-División de Endocrinología, Hospital de Niños Ricardo Gutiérrez, C1425EFD Buenos Aires, Argentina
| | - Jean-Yves Picard
- Inserm UMR_S938, Centre de Recherche Saint Antoine, Sorbonne Université, IHU ICAN, Paris, France
| | - Clara Valeri
- Centro de Investigaciones Endocrinológicas ‘Dr. César Bergadá’ (CEDIE), CONICET-FEI-División de Endocrinología, Hospital de Niños Ricardo Gutiérrez, C1425EFD Buenos Aires, Argentina
| | - Ian Marshall
- Division of Pediatric Endocrinology, Rutgers-Robert Wood Johnson Medical School, Child Health Institute of New Jersey, New Brunswick, NJ, USA
| | - Dominique Treton
- Inserm UMR_S938, Centre de Recherche Saint Antoine, Sorbonne Université, IHU ICAN, Paris, France
| | - Nathalie di Clemente
- Inserm UMR_S938, Centre de Recherche Saint Antoine, Sorbonne Université, IHU ICAN, Paris, France
| | - Rodolfo A Rey
- Centro de Investigaciones Endocrinológicas ‘Dr. César Bergadá’ (CEDIE), CONICET-FEI-División de Endocrinología, Hospital de Niños Ricardo Gutiérrez, C1425EFD Buenos Aires, Argentina
| | - Nathalie Josso
- Inserm UMR_S938, Centre de Recherche Saint Antoine, Sorbonne Université, IHU ICAN, Paris, France
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Gomes LG, Bachega TA, Mendonca BB. Classic congenital adrenal hyperplasia and its impact on reproduction. Fertil Steril 2019; 111:7-12. [DOI: 10.1016/j.fertnstert.2018.11.037] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Revised: 11/25/2018] [Accepted: 11/27/2018] [Indexed: 01/30/2023]
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Miller WL. MECHANISMS IN ENDOCRINOLOGY: Rare defects in adrenal steroidogenesis. Eur J Endocrinol 2018; 179:R125-R141. [PMID: 29880708 DOI: 10.1530/eje-18-0279] [Citation(s) in RCA: 53] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Accepted: 06/06/2018] [Indexed: 12/12/2022]
Abstract
Congenital adrenal hyperplasia (CAH) is a group of genetic disorders of adrenal steroidogenesis that impair cortisol synthesis, with compensatory increases in ACTH leading to hyperplastic adrenals. The term 'CAH' is generally used to mean 'steroid 21-hydroxylase deficiency' (21OHD) as 21OHD accounts for about 95% of CAH in most populations; the incidences of the rare forms of CAH vary with ethnicity and geography. These forms of CAH are easily understood on the basis of the biochemistry of steroidogenesis. Defects in the steroidogenic acute regulatory protein, StAR, disrupt all steroidogenesis and are the second-most common form of CAH in Japan and Korea; very rare defects in the cholesterol side-chain cleavage enzyme, P450scc, are clinically indistinguishable from StAR defects. Defects in 3β-hydroxysteroid dehydrogenase, which also causes disordered sexual development, were once thought to be fairly common, but genetic analyses show that steroid measurements are generally unreliable for this disorder. Defects in 17-hydroxylase/17,20-lyase ablate synthesis of sex steroids and also cause mineralocorticoid hypertension; these are common in Brazil and in China. Isolated 17,20-lyase deficiency can be caused by rare mutations in at least three different proteins. P450 oxidoreductase (POR) is a co-factor used by 21-hydroxylase, 17-hydroxylase/17,20-lyase and aromatase; various POR defects, found in different populations, affect these enzymes differently. 11-Hydroxylase deficiency is the second-most common form of CAH in European populations but the retention of aldosterone synthesis distinguishes it from 21OHD. Aldosterone synthase deficiency is a rare salt-losing disorder. Mild, 'non-classic' defects in all of these factors have been described. Both the severe and non-classic disorders can be treated if recognized.
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Affiliation(s)
- Walter L Miller
- Department of Pediatrics, Center for Reproductive Sciences, and Institute of Human Genetics, University of California, San Francisco, California, USA
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Selvaraj V, Stocco DM, Clark BJ. Current knowledge on the acute regulation of steroidogenesis. Biol Reprod 2018; 99:13-26. [PMID: 29718098 PMCID: PMC6044331 DOI: 10.1093/biolre/ioy102] [Citation(s) in RCA: 74] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2017] [Revised: 02/23/2018] [Accepted: 04/26/2018] [Indexed: 12/31/2022] Open
Abstract
How rapid induction of steroid hormone biosynthesis occurs in response to trophic hormone stimulation of steroidogenic cells has been a subject of intensive investigation for approximately six decades. A key observation made very early was that acute regulation of steroid biosynthesis required swift and timely synthesis of a new protein whose role appeared to be involved in the delivery of the substrate for all steroid hormones, cholesterol, from the outer to the inner mitochondrial membrane where the process of steroidogenesis begins. It was quickly learned that this transfer of cholesterol to the inner mitochondrial membrane was the regulated and rate-limiting step in steroidogenesis. Following this observation, the quest for this putative regulator protein(s) began in earnest in the late 1950s. This review provides a history of this quest, the candidate proteins that arose over the years and facts surrounding their rise or decline. Only two have persisted-translocator protein (TSPO) and the steroidogenic acute regulatory protein (StAR). We present a detailed summary of the work that has been published for each of these two proteins, the specific data that has appeared in support of their role in cholesterol transport and steroidogenesis, and the ensuing observations that have arisen in recent years that have refuted the role of TSPO in this process. We believe that the only viable candidate that has been shown to be indispensable is the StAR protein. Lastly, we provide our view on what may be the most important questions concerning the acute regulation of steroidogenesis that need to be asked in future.
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Affiliation(s)
- Vimal Selvaraj
- Department of Animal Science, College of Agriculture and Life Sciences, Cornell University, Ithaca, New York, USA
| | - Douglas M Stocco
- Department of Cell Biology and Biochemistry, Texas Tech University Health Sciences Center, Lubbock, Texas, USA
| | - Barbara J Clark
- Department of Biochemistry and Molecular Genetics, University of Louisville, Louisville, Kentucky, USA
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Baranowski ES, Arlt W, Idkowiak J. Monogenic Disorders of Adrenal Steroidogenesis. Horm Res Paediatr 2018; 89:292-310. [PMID: 29874650 PMCID: PMC6067656 DOI: 10.1159/000488034] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2018] [Accepted: 02/27/2018] [Indexed: 12/19/2022] Open
Abstract
Disorders of adrenal steroidogenesis comprise autosomal recessive conditions affecting steroidogenic enzymes of the adrenal cortex. Those are located within the 3 major branches of the steroidogenic machinery involved in the production of mineralocorticoids, glucocorticoids, and androgens. This mini review describes the principles of adrenal steroidogenesis, including the newly appreciated 11-oxygenated androgen pathway. This is followed by a description of pathophysiology, biochemistry, and clinical implications of steroidogenic disorders, including mutations affecting cholesterol import and steroid synthesis, the latter comprising both mutations affecting steroidogenic enzymes and co-factors required for efficient catalysis. A good understanding of adrenal steroidogenic pathways and their regulation is crucial as the basis for sound management of these disorders, which in the majority present in early childhood.
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Affiliation(s)
- Elizabeth S. Baranowski
- Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, United Kingdom,Centre for Endocrinology, Diabetes and Metabolism, Birmingham Health Partners, Birmingham, United Kingdom,Department of Paediatric Endocrinology and Diabetes, Birmingham Women's and Children's Hospital NHS Foundation Trust, Birmingham, United Kingdom
| | - Wiebke Arlt
- Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, United Kingdom,Centre for Endocrinology, Diabetes and Metabolism, Birmingham Health Partners, Birmingham, United Kingdom,*Prof. Wiebke Arlt, Institute of Metabolism and Systems Research (IMSR), University of Birmingham, Birmingham B15 2TT (UK), E-Mail
| | - Jan Idkowiak
- Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, United Kingdom,Centre for Endocrinology, Diabetes and Metabolism, Birmingham Health Partners, Birmingham, United Kingdom,Department of Paediatric Endocrinology and Diabetes, Birmingham Women's and Children's Hospital NHS Foundation Trust, Birmingham, United Kingdom
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18
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Fu R, Lu L, Jiang J, Nie M, Wang X, Lu Z. A case report of pedigree of a homozygous mutation of the steroidogenic acute regulatory protein causing lipoid congenital adrenal hyperplasia. Medicine (Baltimore) 2017; 96:e6994. [PMID: 28538409 PMCID: PMC5457889 DOI: 10.1097/md.0000000000006994] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
RATIONALE Lipoid congenital adrenal hyperplasia (LCAH) is extremely rare, but is the most fatal form of congenital adrenal hyperplasia resulting from mutations in the steroidogenic acute regulatory protein (STAR) gene. LCAH arises from severe defects in the conversion of cholesterol to pregnenolone, the precursor of all steroids. PATIENT CONCERNS A case was reported that an 11-month-old Chinese girl who presented with a sex development disorder and hyponatremia. The clinical and genetic tests were carried out to confirm the diagnosis. The genogram of this case was also explored and analyzed. The girl presented with hyponatremia, decreased cortisol level, elevated adrenocorticotropic hormone level and female vulva despite a 46, XY karyotype. Enlarged adrenal glands and testicular-like tissue in the bilateral inguinal regions were detected with abdominal ultrasound. She was suspected of having LCAH, and definitive diagnosis was made after Sanger sequencing detected a homozygous frameshift variant c.707_708delins CTT (p.Lys236Thrfs*47) on exon 6 of the STAR gene. DIAGNOSES LCAH. INTERVENTIONS She was prescribed hydrocortisone 10 to 12 mg/m2 and 9a- fludrocortisone 100 mg/d. OUTCOMES Her skin hyperpigmentation and vomiting disappeared, and she had normal growth and development without adrenal crisis attacks. Her hormone and electrolyte levels remained normal, except for a persistently elevated ACTH level throughout 2 years of follow-up. At follow-up for 2 years, the patient is now 104.5 cm tall and weighs 23.3 kg at the age of 4 years old. Her plasma sodium and potassium concentration were normal. Her ACTH level is still elevated (1176 pg/mL). Her baseline sex hormone levels are testosterone <0.1 ng/dL and progesterone <0.08 ng/dL. The level of PRA (1.06 ng/mL per h) is within normal range. LESSONS This mutation was in accordance with previously reported gene mutations. The patient's parents were nonconsanguineous; her parents, paternal grandfather, and maternal grandmother were all found to be carriers of a STAR gene mutation. This 46 XY disorders of sex development case presented with adrenal insufficiency and female phenotype initially. The diagnosis was complicated depending on the clinical hormone workup. LCAH was confirmed by genetic tests and genogram of the family.
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MESH Headings
- Adrenal Hyperplasia, Congenital/diagnosis
- Adrenal Hyperplasia, Congenital/drug therapy
- Adrenal Hyperplasia, Congenital/genetics
- Diagnosis, Differential
- Disorder of Sex Development, 46,XY/diagnosis
- Disorder of Sex Development, 46,XY/drug therapy
- Disorder of Sex Development, 46,XY/genetics
- Female
- Frameshift Mutation
- Homozygote
- Humans
- Infant
- Pedigree
- Phosphoproteins/genetics
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Affiliation(s)
- Rong Fu
- Department of Endocrinology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Science, Key Laboratory of Health and Family Planning Commission, Beijing, China
| | - Lin Lu
- Department of Endocrinology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Science, Key Laboratory of Health and Family Planning Commission, Beijing, China
| | - Jun Jiang
- The Key Laboratory of Genome Sciences and Information, Beijing Institute of Genomics, Chinese Academy of Sciences, Beijing, China
| | - Min Nie
- Department of Endocrinology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Science, Key Laboratory of Health and Family Planning Commission, Beijing, China
| | - Xiaojing Wang
- Department of Endocrinology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Science, Key Laboratory of Health and Family Planning Commission, Beijing, China
| | - Zhaolin Lu
- Department of Endocrinology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Science, Key Laboratory of Health and Family Planning Commission, Beijing, China
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Miller WL. Disorders in the initial steps of steroid hormone synthesis. J Steroid Biochem Mol Biol 2017; 165:18-37. [PMID: 26960203 DOI: 10.1016/j.jsbmb.2016.03.009] [Citation(s) in RCA: 120] [Impact Index Per Article: 17.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2015] [Revised: 03/01/2016] [Accepted: 03/03/2016] [Indexed: 12/29/2022]
Abstract
Steroidogenesis begins with cellular internalization of low-density lipoprotein particles and subsequent intracellular processing of cholesterol. Disorders in these steps include Adrenoleukodystrophy, Wolman Disease and its milder variant Cholesterol Ester Storage Disease, and Niemann-Pick Type C Disease, all of which may present with adrenal insufficiency. The means by which cholesterol is directed to steroidogenic mitochondria remains incompletely understood. Once cholesterol reaches the outer mitochondrial membrane, its delivery to the inner mitochondrial membrane is regulated by the steroidogenic acute regulatory protein (StAR). Severe StAR mutations cause classic congenital lipoid adrenal hyperplasia, characterized by lipid accumulation in the adrenal, adrenal insufficiency, and disordered sexual development in 46,XY individuals. The lipoid CAH phenotype, including spontaneous puberty in 46,XX females, is explained by a two-hit model. StAR mutations that retain partial function cause a milder, non-classic disease characterized by glucocorticoid deficiency, with lesser disorders of mineralocorticoid and sex steroid synthesis. Once inside the mitochondria, cholesterol is converted to pregnenolone by the cholesterol side-chain cleavage enzyme, P450scc, encoded by the CYP11A1 gene. Rare patients with mutations of P450scc are clinically and hormonally indistinguishable from those with lipoid CAH, and may also present as milder non-classic disease. Patients with P450scc defects do not have the massive adrenal hyperplasia that characterizes lipoid CAH, but adrenal imaging may occasionally fail to distinguish these, necessitating DNA sequencing.
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Affiliation(s)
- Walter L Miller
- Center for Reproductive Sciences, University of California, San Francisco, CA 94143-0556, United States.
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Khoury K, Barbar E, Ainmelk Y, Ouellet A, Lavigne P, LeHoux JG. Thirty-Eight-Year Follow-Up of Two Sibling Lipoid Congenital Adrenal Hyperplasia Patients Due to Homozygous Steroidogenic Acute Regulatory (STARD1) Protein Mutation. Molecular Structure and Modeling of the STARD1 L275P Mutation. Front Neurosci 2016; 10:527. [PMID: 27917104 PMCID: PMC5116571 DOI: 10.3389/fnins.2016.00527] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2016] [Accepted: 10/31/2016] [Indexed: 11/13/2022] Open
Abstract
Objective: Review the impact of StAR (STARD1) mutations on steroidogenesis and fertility in LCAH patients. Examine the endocrine mechanisms underlying the pathology of the disorder and the appropriate therapy for promoting fertility and pregnancies. Design: Published data in the literature and a detailed 38-year follow-up of two sibling LCAH patients. Molecular structure and modeling of the STARD1 L275P mutation. Setting: University hospital. Patients: Patient A (46,XY female phenotype) and patient B (46,XX female) with LCAH bearing the L275P mutation in STARD1. Interventions: Since early-age diagnosis, both patients underwent corticoid replacement therapy. Patient A received estrogen therapy at pubertal age. Clomiphene therapy was given to Patient B to induce ovulation. Pregnancies were protected with progesterone administration. Main Outcome Measures: Clinical and molecular assessment of adrenal and gonadal functions. Results: Both patients have classic manifestations of corticosteroid deficiency observed in LCAH. Time of onset and severity were different. Patient A developed into a female phenotype due to early and severe damage of Leydig cells. Patient B started a progressive pubertal development, menarche and regular non-ovulatory cycle. She was able to have successful pregnancies. Conclusions: Understanding the molecular structure and function of STARD1 in all steroidogenic tissues is the key for comprehending the heterogeneous clinical manifestations of LCAH, and the development of an appropriate strategy for the induction of ovulation and protecting pregnancies in this disease.
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Affiliation(s)
- Khalil Khoury
- Department of Pediatrics, Faculty of Medicine, University of Sherbrooke Sherbrooke, QC, Canada
| | - Elie Barbar
- Department of Biochemistry, Faculty of Medicine, University of Sherbrooke Sherbrooke, QC, Canada
| | - Youssef Ainmelk
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Sherbrooke Sherbrooke, QC, Canada
| | - Annie Ouellet
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Sherbrooke Sherbrooke, QC, Canada
| | - Pierre Lavigne
- Department of Biochemistry, Faculty of Medicine, University of Sherbrooke Sherbrooke, QC, Canada
| | - Jean-Guy LeHoux
- Department of Biochemistry, Faculty of Medicine, University of Sherbrooke Sherbrooke, QC, Canada
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Ishii T, Fukuzawa R, Sato T, Muroya K, Adachi M, Ihara K, Igaki J, Hasegawa Y, Sato S, Mitsui T, Hasegawa T. Gonadal macrophage infiltration in congenital lipoid adrenal hyperplasia. Eur J Endocrinol 2016; 175:127-32. [PMID: 27190208 DOI: 10.1530/eje-16-0194] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2016] [Accepted: 05/17/2016] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Congenital lipoid adrenal hyperplasia (lipoid CAH) results in impairment of adrenal and gonadal steroidogenesis caused by STAR mutations. Our previous study revealed upregulation of genes associated with inflammatory or immune response and macrophage infiltration in the adrenal cortex of Star-knockout mice. This study aimed at investigating macrophage infiltration in the gonads from human patients with lipoid CAH. DESIGN This study includes seven patients with lipoid CAH who underwent gonadectomy: two XX women (age, 22 and 40 years) and five XY boys (1 year). Two women with ovarian cysts (32 and 40 years) and six boys with autopsy or tumor (1 year) were examined as controls. Immunohistochemical analysis of their gonads was performed to determine steroidogenic cells by NR5A1 or CYP17A1 and macrophages by IBA1 or CD68. RESULTS An increased number of macrophages infiltrated into the ovaries of lipoid CAH and consisted of two subpopulations: one scattered within and around a layer of theca cells of maturing follicles and the other massively aggregated in the stroma. Abundant cytoplasmic lipid droplets were observed not only in the theca cells but also in the stromal macrophages. There was no significant difference in the number of macrophages in the testicular interstitium between lipoid CAH (95% confidence interval (95% CI: 19.3-47.7 per 0.2mm(2)) and controls (95% CI: 13.3-25.8 per 0.2mm(2)) (P=0.10). CONCLUSIONS These results demonstrate that macrophages infiltrate the ovaries of lipoid CAH, where the theca cells and the stromal macrophages have abundant cytoplasmic lipid droplets.
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Affiliation(s)
- Tomohiro Ishii
- Department of PediatricsKeio University School of Medicine, Tokyo, Japan
| | - Ryuji Fukuzawa
- Department of Pathology and Laboratory MedicineTokyo Metropolitan Children's Medical Center, Tokyo, Japan
| | - Takeshi Sato
- Department of PediatricsKeio University School of Medicine, Tokyo, Japan Department of Endocrinology and MetabolismKanagawa Children's Medical Center, Yokohama, Japan
| | - Koji Muroya
- Department of Endocrinology and MetabolismKanagawa Children's Medical Center, Yokohama, Japan
| | - Masanori Adachi
- Department of Endocrinology and MetabolismKanagawa Children's Medical Center, Yokohama, Japan
| | - Kenji Ihara
- Department of PediatricsGraduate School of Medical Sciences, Kyushu University, Fukuoka, Japan, and
| | - Junko Igaki
- Department of Endocrinology and MetabolismTokyo Metropolitan Children's Medical Center, Tokyo, Japan
| | - Yukihiro Hasegawa
- Department of Endocrinology and MetabolismTokyo Metropolitan Children's Medical Center, Tokyo, Japan
| | - Seiji Sato
- Department of PediatricsSaitama Municipal Hospital, Saitama, Japan
| | - Toshikatsu Mitsui
- Department of PediatricsKeio University School of Medicine, Tokyo, Japan
| | - Tomonobu Hasegawa
- Department of PediatricsKeio University School of Medicine, Tokyo, Japan
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Carvalho LCD, Brito VN, Martin RM, Zamboni AM, Gomes LG, Inácio M, Mermejo LM, Coeli-Lacchini F, Teixeira VR, Gonçalves FT, Carrilho AJF, Del Toro Camargo KY, Finkielstain GP, Taboada GF, Frade Costa EM, Domenice S, Mendonca BB. Clinical, hormonal, ovarian, and genetic aspects of 46,XX patients with congenital adrenal hyperplasia due to CYP17A1 defects. Fertil Steril 2016; 105:1612-9. [DOI: 10.1016/j.fertnstert.2016.02.008] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2015] [Revised: 02/04/2016] [Accepted: 02/04/2016] [Indexed: 12/13/2022]
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Manna PR, Stetson CL, Slominski AT, Pruitt K. Role of the steroidogenic acute regulatory protein in health and disease. Endocrine 2016; 51:7-21. [PMID: 26271515 PMCID: PMC4707056 DOI: 10.1007/s12020-015-0715-6] [Citation(s) in RCA: 119] [Impact Index Per Article: 14.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2015] [Accepted: 08/03/2015] [Indexed: 01/10/2023]
Abstract
Steroid hormones are an important class of regulatory molecules that are synthesized in steroidogenic cells of the adrenal, ovary, testis, placenta, brain, and skin, and influence a spectrum of developmental and physiological processes. The steroidogenic acute regulatory protein (STAR) predominantly mediates the rate-limiting step in steroid biosynthesis, i.e., the transport of the substrate of all steroid hormones, cholesterol, from the outer to the inner mitochondrial membrane. At the inner membrane, cytochrome P450 cholesterol side chain cleavage enzyme cleaves the cholesterol side chain to form the first steroid, pregnenolone, which is converted by a series of enzymes to various steroid hormones in specific tissues. Both basic and clinical evidence have demonstrated the crucial involvement of the STAR protein in the regulation of steroid biosynthesis. Multiple levels of regulation impinge on STAR action. Recent findings demonstrate that hormone-sensitive lipase, through its action on the hydrolysis of cholesteryl esters, plays an important role in regulating STAR expression and steroidogenesis which involve the liver X receptor pathway. Activation of the latter influences macrophage cholesterol efflux that is a key process in the prevention of atherosclerotic cardiovascular disease. Appropriate regulation of steroid hormones is vital for proper functioning of many important biological activities, which are also paramount for geriatric populations to live longer and healthier. This review summarizes the current level of understanding on tissue-specific and hormone-induced regulation of STAR expression and steroidogenesis, and provides insights into a number of cholesterol and/or steroid coupled physiological and pathophysiological consequences.
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Affiliation(s)
- Pulak R Manna
- Department of Immunology and Molecular Microbiology, School of Medicine, Texas Tech University Health Sciences Center, Lubbock, TX, 79430, USA.
| | - Cloyce L Stetson
- Department of Dermatology, Texas Tech University Health Sciences Center, Lubbock, TX, 79430, USA
| | - Andrzej T Slominski
- Department of Dermatology, VA Medical Center, University of Alabama Birmingham, Birmingham, AL, 35294, USA
| | - Kevin Pruitt
- Department of Immunology and Molecular Microbiology, School of Medicine, Texas Tech University Health Sciences Center, Lubbock, TX, 79430, USA
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Salenave S, Bernard V, Do Cao C, Guignat L, Bachelot A, Leboulleux S, Droumaguet C, Bry-Gauillard H, Pierre P, Crinière L, Santulli P, Touraine P, Chanson P, Schlumberger M, Maiter D, Baudin E, Young J. Ovarian macrocysts and gonadotrope-ovarian axis disruption in premenopausal women receiving mitotane for adrenocortical carcinoma or Cushing's disease. Eur J Endocrinol 2015; 172:141-9. [PMID: 25411236 DOI: 10.1530/eje-14-0670] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
CONTEXT Mitotane is an adrenolytic and anticortisolic drug used in adrenocortical carcinoma (ACC), Cushing's disease (CD), and ectopic ACTH syndrome. Its effects on the ovaries are unknown. OBJECTIVE To evaluate the ovarian and gonadotrope effects of mitotane therapy in premenopausal women. PATIENTS We studied 21 premenopausal women (ACC: n=13; CD: n=8; median age 33 years, range 18-45 years) receiving mitotane at a median initial dose of 3 g/day (range 1.5-6 g/day). METHODS Gynecological history was collected and ovarian ultrasound was performed. Four women also underwent ovarian CT or magnetic resonance imaging. Serum gonadotropin, estradiol (E2), androgens, sex hormone-binding globulin (SHBG), and circulating mitotane levels were determined at diagnosis and during mitotane therapy. RESULTS In the women included, ovarian macrocysts (bilateral in 51%) were detected after a median 11 months (range: 3-36) of mitotane exposure. The median number of macrocysts per woman was two (range: 1-4) and the median diameter of the largest cysts was 50 mm (range: 26-90). Menstrual irregularities and/or pelvic pain were present in 15 out of 21 women at macrocyst diagnosis. In two women, the macrocysts were revealed by complications (ovarian torsion and hemorrhagic macrocyst rupture) that required surgery. Mitotane therapy was associated with a significant decrease in androstenedione and testosterone levels and a significant increase in LH levels. Serum FSH and E2 levels were also increased, and SHBG levels rose markedly. CONCLUSIONS Mitotane therapy causes significant morphological and ovarian/gonadotrope hormonal abnormalities in premenopausal women. Follicular thecal steroid synthesis appears to be specifically altered and the subsequent increase in gonadotropins might explain the development of macrocysts. The mechanisms underlying these adverse effects, whose exact prevalence in this population still needs to be determined, are discussed.
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Affiliation(s)
- Sylvie Salenave
- Faculté de Médecine Paris-SudUniv Paris-Sud, Le Kremlin Bicêtre, FranceAssistance Publique-Hôpitaux de ParisService d'Endocrinologie et des Maladies de la Reproduction, Hôpital Bicêtre, 78 rue du General Leclerc, F-94275 Le Kremlin Bicêtre, FranceINSERM U693Le Kremlin-Bicêtre, FranceService d'EndocrinologieCentre Hospitalier Régional Universitaire de Lille, Lille, FranceAssistance Publique-Hôpitaux de ParisService d'Endocrinologie Hôpital Cochin, Paris, FranceAssistance Publique-Hôpitaux de ParisService d'Endocrinologie et Médecine de la Reproduction, Hôpital Pitié-Salpêtrière, Paris, FranceInstitut Gustave RoussyDépartement de Médecine Nucléaire et Oncologie endocrinienne, Villejuif, FranceService de Médecine Interne CHU Henri MondorCréteil, FranceService d'EndocrinologieCentre Hospitalier Universitaire de Tours, Tours, FranceService de Gynécologie ObstétriqueHôpital Cochin, Paris, FranceDépartement d'Endocrinologie et NutritionCliniques Saint-Luc, Université Catholique de Louvain, Bruxelles, Belgium Faculté de Médecine Paris-SudUniv Paris-Sud, Le Kremlin Bicêtre, FranceAssistance Publique-Hôpitaux de ParisService d'Endocrinologie et des Maladies de la Reproduction, Hôpital Bicêtre, 78 rue du General Leclerc, F-94275 Le Kremlin Bicêtre, FranceINSERM U693Le Kremlin-Bicêtre, FranceService d'EndocrinologieCentre Hospitalier Régional Universitaire de Lille, Lille, FranceAssistance Publique-Hôpitaux de ParisService d'Endocrinologie Hôpital Cochin, Paris, FranceAssistance Publique-Hôpitaux de ParisService d'Endocrinologie et Médecine de la Reproduction, Hôpital Pitié-Salpêtrière, Paris, FranceInstitut Gustave RoussyDépartement de Médecine Nucléaire et Oncologie endocrinienne, Villejuif, FranceService de Médecine Interne CHU Henri MondorCréteil, FranceService d'EndocrinologieCentre Hospitalier Universitaire de Tours, Tours, FranceService de Gynécologie ObstétriqueHôpital Cochin, Paris, FranceDépartement d'Endocrinologie
| | - Valérie Bernard
- Faculté de Médecine Paris-SudUniv Paris-Sud, Le Kremlin Bicêtre, FranceAssistance Publique-Hôpitaux de ParisService d'Endocrinologie et des Maladies de la Reproduction, Hôpital Bicêtre, 78 rue du General Leclerc, F-94275 Le Kremlin Bicêtre, FranceINSERM U693Le Kremlin-Bicêtre, FranceService d'EndocrinologieCentre Hospitalier Régional Universitaire de Lille, Lille, FranceAssistance Publique-Hôpitaux de ParisService d'Endocrinologie Hôpital Cochin, Paris, FranceAssistance Publique-Hôpitaux de ParisService d'Endocrinologie et Médecine de la Reproduction, Hôpital Pitié-Salpêtrière, Paris, FranceInstitut Gustave RoussyDépartement de Médecine Nucléaire et Oncologie endocrinienne, Villejuif, FranceService de Médecine Interne CHU Henri MondorCréteil, FranceService d'EndocrinologieCentre Hospitalier Universitaire de Tours, Tours, FranceService de Gynécologie ObstétriqueHôpital Cochin, Paris, FranceDépartement d'Endocrinologie et NutritionCliniques Saint-Luc, Université Catholique de Louvain, Bruxelles, Belgium Faculté de Médecine Paris-SudUniv Paris-Sud, Le Kremlin Bicêtre, FranceAssistance Publique-Hôpitaux de ParisService d'Endocrinologie et des Maladies de la Reproduction, Hôpital Bicêtre, 78 rue du General Leclerc, F-94275 Le Kremlin Bicêtre, FranceINSERM U693Le Kremlin-Bicêtre, FranceService d'EndocrinologieCentre Hospitalier Régional Universitaire de Lille, Lille, FranceAssistance Publique-Hôpitaux de ParisService d'Endocrinologie Hôpital Cochin, Paris, FranceAssistance Publique-Hôpitaux de ParisService d'Endocrinologie et Médecine de la Reproduction, Hôpital Pitié-Salpêtrière, Paris, FranceInstitut Gustave RoussyDépartement de Médecine Nucléaire et Oncologie endocrinienne, Villejuif, FranceService de Médecine Interne CHU Henri MondorCréteil, FranceService d'EndocrinologieCentre Hospitalier Universitaire de Tours, Tours, FranceService de Gynécologie ObstétriqueHôpital Cochin, Paris, FranceDépartement d'Endocrinologie
| | - Christine Do Cao
- Faculté de Médecine Paris-SudUniv Paris-Sud, Le Kremlin Bicêtre, FranceAssistance Publique-Hôpitaux de ParisService d'Endocrinologie et des Maladies de la Reproduction, Hôpital Bicêtre, 78 rue du General Leclerc, F-94275 Le Kremlin Bicêtre, FranceINSERM U693Le Kremlin-Bicêtre, FranceService d'EndocrinologieCentre Hospitalier Régional Universitaire de Lille, Lille, FranceAssistance Publique-Hôpitaux de ParisService d'Endocrinologie Hôpital Cochin, Paris, FranceAssistance Publique-Hôpitaux de ParisService d'Endocrinologie et Médecine de la Reproduction, Hôpital Pitié-Salpêtrière, Paris, FranceInstitut Gustave RoussyDépartement de Médecine Nucléaire et Oncologie endocrinienne, Villejuif, FranceService de Médecine Interne CHU Henri MondorCréteil, FranceService d'EndocrinologieCentre Hospitalier Universitaire de Tours, Tours, FranceService de Gynécologie ObstétriqueHôpital Cochin, Paris, FranceDépartement d'Endocrinologie et NutritionCliniques Saint-Luc, Université Catholique de Louvain, Bruxelles, Belgium
| | - Laurence Guignat
- Faculté de Médecine Paris-SudUniv Paris-Sud, Le Kremlin Bicêtre, FranceAssistance Publique-Hôpitaux de ParisService d'Endocrinologie et des Maladies de la Reproduction, Hôpital Bicêtre, 78 rue du General Leclerc, F-94275 Le Kremlin Bicêtre, FranceINSERM U693Le Kremlin-Bicêtre, FranceService d'EndocrinologieCentre Hospitalier Régional Universitaire de Lille, Lille, FranceAssistance Publique-Hôpitaux de ParisService d'Endocrinologie Hôpital Cochin, Paris, FranceAssistance Publique-Hôpitaux de ParisService d'Endocrinologie et Médecine de la Reproduction, Hôpital Pitié-Salpêtrière, Paris, FranceInstitut Gustave RoussyDépartement de Médecine Nucléaire et Oncologie endocrinienne, Villejuif, FranceService de Médecine Interne CHU Henri MondorCréteil, FranceService d'EndocrinologieCentre Hospitalier Universitaire de Tours, Tours, FranceService de Gynécologie ObstétriqueHôpital Cochin, Paris, FranceDépartement d'Endocrinologie et NutritionCliniques Saint-Luc, Université Catholique de Louvain, Bruxelles, Belgium
| | - Anne Bachelot
- Faculté de Médecine Paris-SudUniv Paris-Sud, Le Kremlin Bicêtre, FranceAssistance Publique-Hôpitaux de ParisService d'Endocrinologie et des Maladies de la Reproduction, Hôpital Bicêtre, 78 rue du General Leclerc, F-94275 Le Kremlin Bicêtre, FranceINSERM U693Le Kremlin-Bicêtre, FranceService d'EndocrinologieCentre Hospitalier Régional Universitaire de Lille, Lille, FranceAssistance Publique-Hôpitaux de ParisService d'Endocrinologie Hôpital Cochin, Paris, FranceAssistance Publique-Hôpitaux de ParisService d'Endocrinologie et Médecine de la Reproduction, Hôpital Pitié-Salpêtrière, Paris, FranceInstitut Gustave RoussyDépartement de Médecine Nucléaire et Oncologie endocrinienne, Villejuif, FranceService de Médecine Interne CHU Henri MondorCréteil, FranceService d'EndocrinologieCentre Hospitalier Universitaire de Tours, Tours, FranceService de Gynécologie ObstétriqueHôpital Cochin, Paris, FranceDépartement d'Endocrinologie et NutritionCliniques Saint-Luc, Université Catholique de Louvain, Bruxelles, Belgium
| | - Sophie Leboulleux
- Faculté de Médecine Paris-SudUniv Paris-Sud, Le Kremlin Bicêtre, FranceAssistance Publique-Hôpitaux de ParisService d'Endocrinologie et des Maladies de la Reproduction, Hôpital Bicêtre, 78 rue du General Leclerc, F-94275 Le Kremlin Bicêtre, FranceINSERM U693Le Kremlin-Bicêtre, FranceService d'EndocrinologieCentre Hospitalier Régional Universitaire de Lille, Lille, FranceAssistance Publique-Hôpitaux de ParisService d'Endocrinologie Hôpital Cochin, Paris, FranceAssistance Publique-Hôpitaux de ParisService d'Endocrinologie et Médecine de la Reproduction, Hôpital Pitié-Salpêtrière, Paris, FranceInstitut Gustave RoussyDépartement de Médecine Nucléaire et Oncologie endocrinienne, Villejuif, FranceService de Médecine Interne CHU Henri MondorCréteil, FranceService d'EndocrinologieCentre Hospitalier Universitaire de Tours, Tours, FranceService de Gynécologie ObstétriqueHôpital Cochin, Paris, FranceDépartement d'Endocrinologie et NutritionCliniques Saint-Luc, Université Catholique de Louvain, Bruxelles, Belgium
| | - Céline Droumaguet
- Faculté de Médecine Paris-SudUniv Paris-Sud, Le Kremlin Bicêtre, FranceAssistance Publique-Hôpitaux de ParisService d'Endocrinologie et des Maladies de la Reproduction, Hôpital Bicêtre, 78 rue du General Leclerc, F-94275 Le Kremlin Bicêtre, FranceINSERM U693Le Kremlin-Bicêtre, FranceService d'EndocrinologieCentre Hospitalier Régional Universitaire de Lille, Lille, FranceAssistance Publique-Hôpitaux de ParisService d'Endocrinologie Hôpital Cochin, Paris, FranceAssistance Publique-Hôpitaux de ParisService d'Endocrinologie et Médecine de la Reproduction, Hôpital Pitié-Salpêtrière, Paris, FranceInstitut Gustave RoussyDépartement de Médecine Nucléaire et Oncologie endocrinienne, Villejuif, FranceService de Médecine Interne CHU Henri MondorCréteil, FranceService d'EndocrinologieCentre Hospitalier Universitaire de Tours, Tours, FranceService de Gynécologie ObstétriqueHôpital Cochin, Paris, FranceDépartement d'Endocrinologie et NutritionCliniques Saint-Luc, Université Catholique de Louvain, Bruxelles, Belgium
| | - Hélène Bry-Gauillard
- Faculté de Médecine Paris-SudUniv Paris-Sud, Le Kremlin Bicêtre, FranceAssistance Publique-Hôpitaux de ParisService d'Endocrinologie et des Maladies de la Reproduction, Hôpital Bicêtre, 78 rue du General Leclerc, F-94275 Le Kremlin Bicêtre, FranceINSERM U693Le Kremlin-Bicêtre, FranceService d'EndocrinologieCentre Hospitalier Régional Universitaire de Lille, Lille, FranceAssistance Publique-Hôpitaux de ParisService d'Endocrinologie Hôpital Cochin, Paris, FranceAssistance Publique-Hôpitaux de ParisService d'Endocrinologie et Médecine de la Reproduction, Hôpital Pitié-Salpêtrière, Paris, FranceInstitut Gustave RoussyDépartement de Médecine Nucléaire et Oncologie endocrinienne, Villejuif, FranceService de Médecine Interne CHU Henri MondorCréteil, FranceService d'EndocrinologieCentre Hospitalier Universitaire de Tours, Tours, FranceService de Gynécologie ObstétriqueHôpital Cochin, Paris, FranceDépartement d'Endocrinologie et NutritionCliniques Saint-Luc, Université Catholique de Louvain, Bruxelles, Belgium
| | - Peggy Pierre
- Faculté de Médecine Paris-SudUniv Paris-Sud, Le Kremlin Bicêtre, FranceAssistance Publique-Hôpitaux de ParisService d'Endocrinologie et des Maladies de la Reproduction, Hôpital Bicêtre, 78 rue du General Leclerc, F-94275 Le Kremlin Bicêtre, FranceINSERM U693Le Kremlin-Bicêtre, FranceService d'EndocrinologieCentre Hospitalier Régional Universitaire de Lille, Lille, FranceAssistance Publique-Hôpitaux de ParisService d'Endocrinologie Hôpital Cochin, Paris, FranceAssistance Publique-Hôpitaux de ParisService d'Endocrinologie et Médecine de la Reproduction, Hôpital Pitié-Salpêtrière, Paris, FranceInstitut Gustave RoussyDépartement de Médecine Nucléaire et Oncologie endocrinienne, Villejuif, FranceService de Médecine Interne CHU Henri MondorCréteil, FranceService d'EndocrinologieCentre Hospitalier Universitaire de Tours, Tours, FranceService de Gynécologie ObstétriqueHôpital Cochin, Paris, FranceDépartement d'Endocrinologie et NutritionCliniques Saint-Luc, Université Catholique de Louvain, Bruxelles, Belgium
| | - Lise Crinière
- Faculté de Médecine Paris-SudUniv Paris-Sud, Le Kremlin Bicêtre, FranceAssistance Publique-Hôpitaux de ParisService d'Endocrinologie et des Maladies de la Reproduction, Hôpital Bicêtre, 78 rue du General Leclerc, F-94275 Le Kremlin Bicêtre, FranceINSERM U693Le Kremlin-Bicêtre, FranceService d'EndocrinologieCentre Hospitalier Régional Universitaire de Lille, Lille, FranceAssistance Publique-Hôpitaux de ParisService d'Endocrinologie Hôpital Cochin, Paris, FranceAssistance Publique-Hôpitaux de ParisService d'Endocrinologie et Médecine de la Reproduction, Hôpital Pitié-Salpêtrière, Paris, FranceInstitut Gustave RoussyDépartement de Médecine Nucléaire et Oncologie endocrinienne, Villejuif, FranceService de Médecine Interne CHU Henri MondorCréteil, FranceService d'EndocrinologieCentre Hospitalier Universitaire de Tours, Tours, FranceService de Gynécologie ObstétriqueHôpital Cochin, Paris, FranceDépartement d'Endocrinologie et NutritionCliniques Saint-Luc, Université Catholique de Louvain, Bruxelles, Belgium
| | - Pietro Santulli
- Faculté de Médecine Paris-SudUniv Paris-Sud, Le Kremlin Bicêtre, FranceAssistance Publique-Hôpitaux de ParisService d'Endocrinologie et des Maladies de la Reproduction, Hôpital Bicêtre, 78 rue du General Leclerc, F-94275 Le Kremlin Bicêtre, FranceINSERM U693Le Kremlin-Bicêtre, FranceService d'EndocrinologieCentre Hospitalier Régional Universitaire de Lille, Lille, FranceAssistance Publique-Hôpitaux de ParisService d'Endocrinologie Hôpital Cochin, Paris, FranceAssistance Publique-Hôpitaux de ParisService d'Endocrinologie et Médecine de la Reproduction, Hôpital Pitié-Salpêtrière, Paris, FranceInstitut Gustave RoussyDépartement de Médecine Nucléaire et Oncologie endocrinienne, Villejuif, FranceService de Médecine Interne CHU Henri MondorCréteil, FranceService d'EndocrinologieCentre Hospitalier Universitaire de Tours, Tours, FranceService de Gynécologie ObstétriqueHôpital Cochin, Paris, FranceDépartement d'Endocrinologie et NutritionCliniques Saint-Luc, Université Catholique de Louvain, Bruxelles, Belgium
| | - Philippe Touraine
- Faculté de Médecine Paris-SudUniv Paris-Sud, Le Kremlin Bicêtre, FranceAssistance Publique-Hôpitaux de ParisService d'Endocrinologie et des Maladies de la Reproduction, Hôpital Bicêtre, 78 rue du General Leclerc, F-94275 Le Kremlin Bicêtre, FranceINSERM U693Le Kremlin-Bicêtre, FranceService d'EndocrinologieCentre Hospitalier Régional Universitaire de Lille, Lille, FranceAssistance Publique-Hôpitaux de ParisService d'Endocrinologie Hôpital Cochin, Paris, FranceAssistance Publique-Hôpitaux de ParisService d'Endocrinologie et Médecine de la Reproduction, Hôpital Pitié-Salpêtrière, Paris, FranceInstitut Gustave RoussyDépartement de Médecine Nucléaire et Oncologie endocrinienne, Villejuif, FranceService de Médecine Interne CHU Henri MondorCréteil, FranceService d'EndocrinologieCentre Hospitalier Universitaire de Tours, Tours, FranceService de Gynécologie ObstétriqueHôpital Cochin, Paris, FranceDépartement d'Endocrinologie et NutritionCliniques Saint-Luc, Université Catholique de Louvain, Bruxelles, Belgium
| | - Philippe Chanson
- Faculté de Médecine Paris-SudUniv Paris-Sud, Le Kremlin Bicêtre, FranceAssistance Publique-Hôpitaux de ParisService d'Endocrinologie et des Maladies de la Reproduction, Hôpital Bicêtre, 78 rue du General Leclerc, F-94275 Le Kremlin Bicêtre, FranceINSERM U693Le Kremlin-Bicêtre, FranceService d'EndocrinologieCentre Hospitalier Régional Universitaire de Lille, Lille, FranceAssistance Publique-Hôpitaux de ParisService d'Endocrinologie Hôpital Cochin, Paris, FranceAssistance Publique-Hôpitaux de ParisService d'Endocrinologie et Médecine de la Reproduction, Hôpital Pitié-Salpêtrière, Paris, FranceInstitut Gustave RoussyDépartement de Médecine Nucléaire et Oncologie endocrinienne, Villejuif, FranceService de Médecine Interne CHU Henri MondorCréteil, FranceService d'EndocrinologieCentre Hospitalier Universitaire de Tours, Tours, FranceService de Gynécologie ObstétriqueHôpital Cochin, Paris, FranceDépartement d'Endocrinologie et NutritionCliniques Saint-Luc, Université Catholique de Louvain, Bruxelles, Belgium Faculté de Médecine Paris-SudUniv Paris-Sud, Le Kremlin Bicêtre, FranceAssistance Publique-Hôpitaux de ParisService d'Endocrinologie et des Maladies de la Reproduction, Hôpital Bicêtre, 78 rue du General Leclerc, F-94275 Le Kremlin Bicêtre, FranceINSERM U693Le Kremlin-Bicêtre, FranceService d'EndocrinologieCentre Hospitalier Régional Universitaire de Lille, Lille, FranceAssistance Publique-Hôpitaux de ParisService d'Endocrinologie Hôpital Cochin, Paris, FranceAssistance Publique-Hôpitaux de ParisService d'Endocrinologie et Médecine de la Reproduction, Hôpital Pitié-Salpêtrière, Paris, FranceInstitut Gustave RoussyDépartement de Médecine Nucléaire et Oncologie endocrinienne, Villejuif, FranceService de Médecine Interne CHU Henri MondorCréteil, FranceService d'EndocrinologieCentre Hospitalier Universitaire de Tours, Tours, FranceService de Gynécologie ObstétriqueHôpital Cochin, Paris, FranceDépartement d'Endocrinologie
| | - Martin Schlumberger
- Faculté de Médecine Paris-SudUniv Paris-Sud, Le Kremlin Bicêtre, FranceAssistance Publique-Hôpitaux de ParisService d'Endocrinologie et des Maladies de la Reproduction, Hôpital Bicêtre, 78 rue du General Leclerc, F-94275 Le Kremlin Bicêtre, FranceINSERM U693Le Kremlin-Bicêtre, FranceService d'EndocrinologieCentre Hospitalier Régional Universitaire de Lille, Lille, FranceAssistance Publique-Hôpitaux de ParisService d'Endocrinologie Hôpital Cochin, Paris, FranceAssistance Publique-Hôpitaux de ParisService d'Endocrinologie et Médecine de la Reproduction, Hôpital Pitié-Salpêtrière, Paris, FranceInstitut Gustave RoussyDépartement de Médecine Nucléaire et Oncologie endocrinienne, Villejuif, FranceService de Médecine Interne CHU Henri MondorCréteil, FranceService d'EndocrinologieCentre Hospitalier Universitaire de Tours, Tours, FranceService de Gynécologie ObstétriqueHôpital Cochin, Paris, FranceDépartement d'Endocrinologie et NutritionCliniques Saint-Luc, Université Catholique de Louvain, Bruxelles, Belgium Faculté de Médecine Paris-SudUniv Paris-Sud, Le Kremlin Bicêtre, FranceAssistance Publique-Hôpitaux de ParisService d'Endocrinologie et des Maladies de la Reproduction, Hôpital Bicêtre, 78 rue du General Leclerc, F-94275 Le Kremlin Bicêtre, FranceINSERM U693Le Kremlin-Bicêtre, FranceService d'EndocrinologieCentre Hospitalier Régional Universitaire de Lille, Lille, FranceAssistance Publique-Hôpitaux de ParisService d'Endocrinologie Hôpital Cochin, Paris, FranceAssistance Publique-Hôpitaux de ParisService d'Endocrinologie et Médecine de la Reproduction, Hôpital Pitié-Salpêtrière, Paris, FranceInstitut Gustave RoussyDépartement de Médecine Nucléaire et Oncologie endocrinienne, Villejuif, FranceService de Médecine Interne CHU Henri MondorCréteil, FranceService d'EndocrinologieCentre Hospitalier Universitaire de Tours, Tours, FranceService de Gynécologie ObstétriqueHôpital Cochin, Paris, FranceDépartement d'Endocrinologie
| | - Dominique Maiter
- Faculté de Médecine Paris-SudUniv Paris-Sud, Le Kremlin Bicêtre, FranceAssistance Publique-Hôpitaux de ParisService d'Endocrinologie et des Maladies de la Reproduction, Hôpital Bicêtre, 78 rue du General Leclerc, F-94275 Le Kremlin Bicêtre, FranceINSERM U693Le Kremlin-Bicêtre, FranceService d'EndocrinologieCentre Hospitalier Régional Universitaire de Lille, Lille, FranceAssistance Publique-Hôpitaux de ParisService d'Endocrinologie Hôpital Cochin, Paris, FranceAssistance Publique-Hôpitaux de ParisService d'Endocrinologie et Médecine de la Reproduction, Hôpital Pitié-Salpêtrière, Paris, FranceInstitut Gustave RoussyDépartement de Médecine Nucléaire et Oncologie endocrinienne, Villejuif, FranceService de Médecine Interne CHU Henri MondorCréteil, FranceService d'EndocrinologieCentre Hospitalier Universitaire de Tours, Tours, FranceService de Gynécologie ObstétriqueHôpital Cochin, Paris, FranceDépartement d'Endocrinologie et NutritionCliniques Saint-Luc, Université Catholique de Louvain, Bruxelles, Belgium
| | - Eric Baudin
- Faculté de Médecine Paris-SudUniv Paris-Sud, Le Kremlin Bicêtre, FranceAssistance Publique-Hôpitaux de ParisService d'Endocrinologie et des Maladies de la Reproduction, Hôpital Bicêtre, 78 rue du General Leclerc, F-94275 Le Kremlin Bicêtre, FranceINSERM U693Le Kremlin-Bicêtre, FranceService d'EndocrinologieCentre Hospitalier Régional Universitaire de Lille, Lille, FranceAssistance Publique-Hôpitaux de ParisService d'Endocrinologie Hôpital Cochin, Paris, FranceAssistance Publique-Hôpitaux de ParisService d'Endocrinologie et Médecine de la Reproduction, Hôpital Pitié-Salpêtrière, Paris, FranceInstitut Gustave RoussyDépartement de Médecine Nucléaire et Oncologie endocrinienne, Villejuif, FranceService de Médecine Interne CHU Henri MondorCréteil, FranceService d'EndocrinologieCentre Hospitalier Universitaire de Tours, Tours, FranceService de Gynécologie ObstétriqueHôpital Cochin, Paris, FranceDépartement d'Endocrinologie et NutritionCliniques Saint-Luc, Université Catholique de Louvain, Bruxelles, Belgium Faculté de Médecine Paris-SudUniv Paris-Sud, Le Kremlin Bicêtre, FranceAssistance Publique-Hôpitaux de ParisService d'Endocrinologie et des Maladies de la Reproduction, Hôpital Bicêtre, 78 rue du General Leclerc, F-94275 Le Kremlin Bicêtre, FranceINSERM U693Le Kremlin-Bicêtre, FranceService d'EndocrinologieCentre Hospitalier Régional Universitaire de Lille, Lille, FranceAssistance Publique-Hôpitaux de ParisService d'Endocrinologie Hôpital Cochin, Paris, FranceAssistance Publique-Hôpitaux de ParisService d'Endocrinologie et Médecine de la Reproduction, Hôpital Pitié-Salpêtrière, Paris, FranceInstitut Gustave RoussyDépartement de Médecine Nucléaire et Oncologie endocrinienne, Villejuif, FranceService de Médecine Interne CHU Henri MondorCréteil, FranceService d'EndocrinologieCentre Hospitalier Universitaire de Tours, Tours, FranceService de Gynécologie ObstétriqueHôpital Cochin, Paris, FranceDépartement d'Endocrinologie
| | - Jacques Young
- Faculté de Médecine Paris-SudUniv Paris-Sud, Le Kremlin Bicêtre, FranceAssistance Publique-Hôpitaux de ParisService d'Endocrinologie et des Maladies de la Reproduction, Hôpital Bicêtre, 78 rue du General Leclerc, F-94275 Le Kremlin Bicêtre, FranceINSERM U693Le Kremlin-Bicêtre, FranceService d'EndocrinologieCentre Hospitalier Régional Universitaire de Lille, Lille, FranceAssistance Publique-Hôpitaux de ParisService d'Endocrinologie Hôpital Cochin, Paris, FranceAssistance Publique-Hôpitaux de ParisService d'Endocrinologie et Médecine de la Reproduction, Hôpital Pitié-Salpêtrière, Paris, FranceInstitut Gustave RoussyDépartement de Médecine Nucléaire et Oncologie endocrinienne, Villejuif, FranceService de Médecine Interne CHU Henri MondorCréteil, FranceService d'EndocrinologieCentre Hospitalier Universitaire de Tours, Tours, FranceService de Gynécologie ObstétriqueHôpital Cochin, Paris, FranceDépartement d'Endocrinologie et NutritionCliniques Saint-Luc, Université Catholique de Louvain, Bruxelles, Belgium Faculté de Médecine Paris-SudUniv Paris-Sud, Le Kremlin Bicêtre, FranceAssistance Publique-Hôpitaux de ParisService d'Endocrinologie et des Maladies de la Reproduction, Hôpital Bicêtre, 78 rue du General Leclerc, F-94275 Le Kremlin Bicêtre, FranceINSERM U693Le Kremlin-Bicêtre, FranceService d'EndocrinologieCentre Hospitalier Régional Universitaire de Lille, Lille, FranceAssistance Publique-Hôpitaux de ParisService d'Endocrinologie Hôpital Cochin, Paris, FranceAssistance Publique-Hôpitaux de ParisService d'Endocrinologie et Médecine de la Reproduction, Hôpital Pitié-Salpêtrière, Paris, FranceInstitut Gustave RoussyDépartement de Médecine Nucléaire et Oncologie endocrinienne, Villejuif, FranceService de Médecine Interne CHU Henri MondorCréteil, FranceService d'EndocrinologieCentre Hospitalier Universitaire de Tours, Tours, FranceService de Gynécologie ObstétriqueHôpital Cochin, Paris, FranceDépartement d'Endocrinologie
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Abstract
Congenital lipoid adrenal hyperplasia (lipoid CAH) is the most fatal form of CAH, as it disrupts adrenal and gonadal steroidogenesis. Most cases of lipoid CAH are caused by recessive mutations in the gene encoding steroidogenic acute regulatory protein (StAR). Affected patients typically present with signs of severe adrenal failure in early infancy and 46,XY genetic males are phenotypic females due to disrupted testicular androgen secretion. The StAR p.Q258X mutation accounts for about 70% of affected alleles in most patients of Japanese and Korean ancestry. However, it is more prevalent (92.3%) in the Korean population. Recently, some patients have been showed that they had late and mild clinical findings. These cases and studies constitute a new entity of 'nonclassic lipoid CAH'. The cholesterol side-chain cleavage enzyme, P450scc (CYP11A1), plays an essential role converting cholesterol to pregnenolone. Although progesterone production from the fetally derived placenta is necessary to maintain a pregnancy to term, some patients with P450scc mutations have recently been reported. P450scc mutations can also cause lipoid CAH and establish a recently recognized human endocrine disorder.
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Affiliation(s)
- Chan Jong Kim
- Department of Pediatrics, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Korea
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Yüksel B, Kulle AE, Gürbüz F, Welzel M, Kotan D, Mengen E, Holterhus PM, Topaloğlu AK, Grötzinger J, Riepe FG. The novel mutation p.Trp147Arg of the steroidogenic acute regulatory protein causes classic lipoid congenital adrenal hyperplasia with adrenal insufficiency and 46,XY disorder of sex development. Horm Res Paediatr 2014; 80:163-9. [PMID: 23920000 DOI: 10.1159/000354086] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2013] [Accepted: 06/25/2013] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The steroidogenic acute regulatory protein (StAR) is essential for steroidogenesis by mediating cholesterol transfer into mitochondria. Inactivating StAR mutations cause lipoid congenital adrenal hyperplasia. OBJECTIVE AND METHODS To identify causative mutations in a patient presenting with adrenal failure during early infancy. The objective was to study the functional and structural consequences of the novel StAR mutation p.Trp147Arg in a Turkish patient detected in compound heterozygosity with the p.Glu169Lys mutation. RESULTS Transient in vitro expression of the mutant proteins together with P450 side-chain cleavage enzyme, adrenodoxin, and adrenodoxin reductase yielded severely diminished cholesterol conversion of the p.Trp147Arg mutant. The previously described p.Glu169Lys mutant led to significantly lower cholesterol conversion than wild-type StAR protein. As derived from three-dimensional protein modeling, the residue W147 is stabilizing the C-terminal helix in a closed conformation hereby acting as gatekeeper of the ligand cavity of StAR. CONCLUSIONS The novel mutation p.Trp147Arg causes primary adrenal insufficiency and complete sex reversal in the 46,XY patient. Clinical disease, in vitro studies and three-dimensional protein modeling of the mutation p.Trp147Arg underscore the relevance of this highly conserved residue for StAR protein function.
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Affiliation(s)
- Bilgin Yüksel
- Division of Pediatric Endocrinology and Metabolism, Department of Pediatrics, Cukurova University, Balcali/Adana, Turkey
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Camats N, Pandey AV, Fernández-Cancio M, Fernández JM, Ortega AM, Udhane S, Andaluz P, Audí L, Flück CE. STAR splicing mutations cause the severe phenotype of lipoid congenital adrenal hyperplasia: insights from a novel splice mutation and review of reported cases. Clin Endocrinol (Oxf) 2014; 80:191-9. [PMID: 23859637 DOI: 10.1111/cen.12293] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2013] [Revised: 05/29/2013] [Accepted: 07/11/2013] [Indexed: 11/27/2022]
Abstract
OBJECTIVE The steroidogenic acute regulatory protein (StAR) transports cholesterol to the mitochondria for steroidogenesis. Loss of StAR function causes lipoid congenital adrenal hyperplasia (LCAH) which is characterized by impaired synthesis of adrenal and gonadal steroids causing adrenal insufficiency, 46,XY disorder of sex development (DSD) and failure of pubertal development. Partial loss of StAR activity may cause adrenal insufficiency only. PATIENT A newborn girl was admitted for mild dehydration, hyponatremia, hyperkalemia and hypoglycaemia and had normal external female genitalia without hyperpigmentation. Plasma cortisol, 17OH-progesterone, DHEA-S, androstendione and aldosterone were low, while ACTH and plasma renin activity were elevated, consistent with the diagnosis of primary adrenal insufficiency. Imaging showed normal adrenals, and cytogenetics revealed a 46,XX karyotype. She was treated with fluids, hydrocortisone and fludrocortisone. DESIGN, METHODS AND RESULTS Genetic studies revealed a novel homozygous STAR mutation in the 3' acceptor splice site of intron 4, c.466-1G>A (IVS4-1G>A). To test whether this mutation would affect splicing, we performed a minigene experiment with a plasmid construct containing wild-type or mutant StAR gDNA of exons-introns 4-6 in COS-1 cells. The splicing was assessed on total RNA using RT-PCR for STAR cDNAs. The mutant STAR minigene skipped exon 5 completely and changed the reading frame. Thus, it is predicted to produce an aberrant and shorter protein (p.V156GfsX19). Computational analysis revealed that this mutant protein lacks wild-type exons 5-7 which are essential for StAR-cholesterol interaction. CONCLUSIONS STAR c.466-1A skips exon 5 and causes a dramatic change in the C-terminal sequence of the protein, which is essential for StAR-cholesterol interaction. This splicing mutation is a loss-of-function mutation explaining the severe phenotype of our patient. Thus far, all reported splicing mutations of STAR cause a severe impairment of protein function and phenotype.
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Affiliation(s)
- Núria Camats
- Pediatric Endocrinology, Department of Pediatrics and Department of Clinical Research, University Children's Hospital Bern, Bern, Switzerland
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28
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Miller WL. Steroid hormone synthesis in mitochondria. Mol Cell Endocrinol 2013; 379:62-73. [PMID: 23628605 DOI: 10.1016/j.mce.2013.04.014] [Citation(s) in RCA: 277] [Impact Index Per Article: 25.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2013] [Revised: 04/18/2013] [Accepted: 04/19/2013] [Indexed: 11/17/2022]
Abstract
Mitochondria are essential sites for steroid hormone biosynthesis. Mitochondria in the steroidogenic cells of the adrenal, gonad, placenta and brain contain the cholesterol side-chain cleavage enzyme, P450scc, and its two electron-transfer partners, ferredoxin reductase and ferredoxin. This enzyme system converts cholesterol to pregnenolone and determines net steroidogenic capacity, so that it serves as the chronic regulator of steroidogenesis. Several other steroidogenic enzymes, including 3β-hydroxysteroid dehydrogenase, 11β-hydroxylase and aldosterone synthase also reside in mitochondria. Similarly, the mitochondria of renal tubular cells contain two key enzymes participating in the activation and degradation of vitamin D. The access of cholesterol to the mitochondria is regulated by the steroidogenic acute regulatory protein, StAR, serving as the acute regulator of steroidogenesis. StAR action requires a complex multi-component molecular machine on the outer mitochondrial membrane (OMM). Components of this machine include the 18 kDa translocator protein (TSPO), the voltage-dependent anion chanel (VDAC-1), TSPO-associated protein 7 (PAP7, ACBD3), and protein kinase A regulatory subunit 1α (PKAR1A). The precise fashion in which these proteins interact and move cholesterol from the OMM to P450scc, and the means by which cholesterol is loaded into the OMM, remain unclear. Human deficiency diseases have been described for StAR and for all the mitochondrial steroidogenic enzymes, but not for the electron transfer proteins or for the components of the cholesterol import machine.
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Affiliation(s)
- Walter L Miller
- Department of Pediatrics, University of California San Francisco, San Francisco, CA 94143-1346, USA; Division of Endocrinology, University of California San Francisco, San Francisco, CA 94143-1346, USA.
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Gucev ZS, Tee MK, Chitayat D, Wherrett DK, Miller WL. Distinguishing deficiencies in the steroidogenic acute regulatory protein and the cholesterol side chain cleavage enzyme causing neonatal adrenal failure. J Pediatr 2013; 162:819-22. [PMID: 23158025 DOI: 10.1016/j.jpeds.2012.10.012] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2012] [Revised: 08/30/2012] [Accepted: 10/04/2012] [Indexed: 11/27/2022]
Abstract
OBJECTIVES To determine the genetic basis of disordered steroidogenesis in Kuwaiti siblings. STUDY DESIGN Two siblings (46,XX and 46,XY) had normal female external genitalia and severe glucocorticoid and mineralocorticoid deficiency presenting in the first month of life. Abdominal ultrasonography showed normal size adrenal glands, suggesting cholesterol side chain cleavage enzyme (P450scc) deficiency. The CYP11A1 gene encoding P450scc and the STAR gene encoding the steroidogenic acute regulatory protein (StAR) were directly sequenced from leukocyte DNA. RESULTS All exons and intron/exon boundaries of the CYP11A1 gene were normal; the STAR gene was homozygous for a novel 14-base deletion/frameshift in exon 4 (g.4643_4656del), so that no functional protein could be produced. Both parents and an unaffected sibling were heterozygous; zygosity was confirmed with a BsmF1 restriction fragment length polymorphism. CONCLUSIONS Unlike most patients with StAR deficiency, our patients did not have the massive adrenal hyperplasia typical of congenital lipoid adrenal hyperplasia. The distinction between StAR and P450scc deficiency may require gene sequencing.
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Affiliation(s)
- Zoran S Gucev
- Department of Pediatrics, University of California San Francisco, San Francisco, CA 94143, USA
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Sertedaki A, Dracopoulou M, Voutetakis A, Stefanaki K, Rontogianni D, Magiakou AM, Kanaka-Gantenbein C, Chrousos G, Dacou-Voutetakis C. Long-term clinical data and molecular defects in the STAR gene in five Greek patients. Eur J Endocrinol 2013; 168:351-9. [PMID: 23211570 DOI: 10.1530/eje-12-0600] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
CONTEXT Steroidogenic acute regulatory (STAR) gene mutations lead to adrenal and gonadal failure. Interesting, though as yet unexplained, features are the formation of ovarian cysts and the potential presence of CNS findings. OBJECTIVE To report biochemical, genetic, and long-term clinical data in five Greek patients from four different families with STAR gene defects (three 46,XX and two 46,XY). METHODS AND RESULTS All patients presented in early infancy with adrenal insufficiency. The STAR gene mutation c.834del11bp, detected in three of our patients, completely alters the carboxyl end of the STAR protein and has not thus far been described in other population groups. These three patients belong to three separate families, possibly genetically related, as they live in different villages located in a small region of a Greek island. However, their interrelationship has not been proven. A second mutation, p.W250X, detected in our fourth family, was previously described only in two Serbian patients. Ovarian cysts were detected ultrasonographically in our 46,XX patients and seemed to respond to a low dose of a contraceptive. The histology of an excised ovarian cyst was diagnosed as a corpus luteum (CL) cyst. In two out of the four patients who had undergone brain magnetic resonance imaging, asymptomatic Chiari-1 malformation was observed. CONCLUSIONS The occurrence of STAR gene mutation c.834del11bp in three families living in a restricted geographic region could indicate either a founder effect or simply reflect a spread of this defect in a highly related population. The ovarian histological findings suggest that ovarian cysts detected ultrasonographically in 46,XX individuals with STAR gene defects may be CL cysts. The Chiari-1 malformation in two of our patients may be part of the STAR gene mutation phenotype. Nevertheless, more data are needed to confirm or disprove the existence of specific CNS pathology in patients with STAR gene mutations.
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MESH Headings
- 46, XX Disorders of Sex Development/genetics
- 46, XX Disorders of Sex Development/metabolism
- 46, XX Disorders of Sex Development/physiopathology
- Adrenal Insufficiency/congenital
- Adrenal Insufficiency/etiology
- Disorder of Sex Development, 46,XY/genetics
- Disorder of Sex Development, 46,XY/metabolism
- Disorder of Sex Development, 46,XY/physiopathology
- Family Health
- Female
- Genetic Association Studies
- Greece
- Humans
- Infant
- Infant, Newborn
- Mediterranean Islands
- Mutation
- Ovarian Cysts/etiology
- Phosphoproteins/genetics
- Phosphoproteins/metabolism
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Affiliation(s)
- Amalia Sertedaki
- Division of Endocrinology, Diabetes and Metabolism, First Department of Pediatrics, Agia Sophia Children's Hospital, Athens University School of Medicine, Athens, Greece
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Tee MK, Abramsohn M, Loewenthal N, Harris M, Siwach S, Kaplinsky A, Markus B, Birk O, Sheffield VC, Pavari R, Hershkovitz E, Miller WL. Varied clinical presentations of seven patients with mutations in CYP11A1 encoding the cholesterol side-chain cleavage enzyme, P450scc. J Clin Endocrinol Metab 2013; 98:713-20. [PMID: 23337730 PMCID: PMC3565115 DOI: 10.1210/jc.2012-2828] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
CONTEXT The cholesterol side-chain cleavage enzyme P450scc, encoded by CYP11A1, converts cholesterol to pregnenolone to initiate steroidogenesis. P450scc deficiency can disrupt adrenal and gonadal steroidogenesis, resembling congenital lipoid adrenal hyperplasia clinically and hormonally; only 12 such patients have been reported previously. OBJECTIVE We sought to expand clinical and genetic experience with P450scc deficiency. PATIENTS AND METHODS We sequenced candidate genes in 7 children with adrenal insufficiency who lacked disordered sexual development. P450scc missense mutations were recreated in the F2 vector, which expresses the fusion protein P450scc-Ferredoxin Reductase-Ferredoxin. COS-1 cells were transfected, production of pregnenolone was assayed, and apparent kinetic parameters were calculated. Previously described P450scc mutants were assayed in parallel. RESULTS Four of five Bedouin children in one kindred were compound heterozygotes for mutations c.694C>T (Arg232Stop) and c.644T>C (Phe215Ser). Single-nucleotide polymorphism analysis confirmed segregation of these mutations. The fifth kindred member and another Bedouin patient presented in infancy and were homozygous for Arg232Stop. A patient from Fiji presenting in infancy was homozygous for c.358T>C (Arg120Stop). All mutations are novel. As assayed in the F2 fusion protein, P450scc Phe215Ser retained 2.5% of wild-type activity; previously described mutants Leu141Trp and Ala269Val had 2.6% and 12% of wild-type activity, respectively, and Val415Glu and c.835delA lacked detectable activity. CONCLUSIONS Although P450scc is required to produce placental progesterone required to maintain pregnancy, severe mutations in P450scc are compatible with term gestation; milder P450scc mutations may present later without disordered sexual development. Enlarged adrenals usually distinguish steroidogenic acute regulatory protein deficiency from P450scc deficiency, but only DNA sequencing is definitive.
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Miller S, Bhasin N, Urrego H, Moroz K, Rowan BG, Ramayya MS, Makridakis NM. Genetic and epigenetic alterations of steroidogenic factor‑1 in ovarian tumors. Int J Oncol 2012; 42:627-34. [PMID: 23291911 PMCID: PMC3583749 DOI: 10.3892/ijo.2012.1758] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2012] [Accepted: 11/12/2012] [Indexed: 12/30/2022] Open
Abstract
Steroidogenic factor-1 (SF-1), the product of the NR5A1 gene, is an essential transcription factor that is known to regulate steroidogenesis in ovarian epithelia, including the synthesis of progesterone, a suppressor of ovarian cancer. Expression of the SF-1 protein, a potential ovarian tumor suppressor, has been demonstrated in normal OSE cells, but is lost in most ovarian tumors and ovarian tumor cell lines. We examined loss of heterozygosity (LOH) and promoter methylation as potential mechanisms that may explain the loss of SF-1 protein in ovarian tumor tissues. Genotyping of three NR5A1 SNPs in matched tumor/normal tissues identified LOH in 16/36 (44%) of the ovarian tumors successfully analyzed, and somatic mutations (gain of allele) in 10% of the tumors. Furthermore, a methylation-sensitive restriction enzyme method was used to demonstrate statistically significant (p<0.0001) increase in the frequency of NR5A1 gene methylation in ovarian tumors (36/46; 78%) versus normal ovaries (1/11; 9%). These data suggest that the SF-1 encoding gene exhibits frequent genetic (LOH/base substitution) and epigenetic (methylation) somatic alterations in ovarian tumors. These data also present novel molecular mechanisms that may explain the loss of SF-1 protein in ovarian tumors, and its potential role in ovarian carcinogenesis.
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Affiliation(s)
- Sarah Miller
- Ohio Department of Health, Columbus, OH 43215, USA
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Abstract
Adrenal gonadal, placental and brain mitochondria contain several steroidogenic enzymes, notably the cholesterol side chain cleavage enzyme, P450scc, which is the enzymatic rate-limiting step in steroidogenesis which determines cellular steroidogenic capacity. Even before this step, the access of cholesterol to this enzyme system is both rate-limiting and the site of acute regulation via the steroidogenic acute regulatory protein (StAR) which interacts with a complex multi-component 'transduceosome' on the outer mitochondrial membrane (OMM). The components of the transduceosome include the 18 kDa translocator protein (TSPO), the voltage-dependent anion channel (VDAC-1), TSPO-associated protein 7 (PAP7, ACBD3 for acyl-CoA-binding-domain 3), and protein kinase A regulatory subunit 1α (PKAR1A). The precise fashion in which these proteins interact and move cholesterol from the OMM to P450scc, and the means by which cholesterol is loaded into the OMM, remain unclear. Human deficiency diseases have been described for StAR and for P450scc. Mitochondria also contain several 'downstream' steroidogenic enzymes.
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Affiliation(s)
- Vassilios Papadopoulos
- The Research Institute of the McGill University Health Centre, Department of Medicine, McGill University, Montreal, Quebec H3G 1A4, Canada.
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34
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Abstract
Systematic literature review and meta-analysis guided by expert opinion has refined current approaches to the treatment of CAH. The advent of widespread newborn screening has improved outcomes, with lower morbidities and mortality. Future advances may be recognized in the form of more efficient diagnostic tools, physiologic drug delivery, improved surgical methods, and assisted reproductive technologies.
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Khodadad A, Modaresi V, Kiani MA, Rabani A, Pakseresht B. A case of lipoid congenital adrenal hyperplasia presenting with cholestasis. IRANIAN JOURNAL OF PEDIATRICS 2011; 21:539-42. [PMID: 23056846 PMCID: PMC3446141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/29/2010] [Revised: 04/21/2011] [Accepted: 06/11/2011] [Indexed: 10/26/2022]
Abstract
BACKGROUND Lipoid congenital adrenal hyperplasia, is the rarest and usually the most severe form of adrenal steroidogenic defect,which may presents as infantile cholestasis. CASE PRESENTATION Here we present a 45 days old infant who came to our attention with cholestasis and severe intractable vomiting and electrolyte disturbances. Evaluation resulted in diagnosis of congenital adrenal hyperplasia. Hydrocortisone and flodrocortisone improved the symptoms including jaundice and vomiting. Hyponatremia and hyperkalemia also resolved with above mentioned treatment. CONCLUSION Congenital adrenal hyperplasia as one of the causes of neonatal cholestasis should be kept in mind, whenever there are also electrolytes abnormalities.
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Affiliation(s)
- Ahmad Khodadad
- Department of Pediatrics, Tehran University of Medical Sciences, Tehran, Iran,Center of Excellence for pediatrics, Children's Medical Center, Tehran, Iran
| | - Vajiheh Modaresi
- Center of Excellence for pediatrics, Children's Medical Center, Tehran, Iran,Ali-ebne Abitaleb Medical School, Islamic Azad University, Branch of Yazd, Iran,Corresponding Author: Address: Gastroenterology Department, Children's Medical Center, No 62, Dr. Gharib St, Keshavarz Blvd, Tehran, Iran. E-mail:
| | - Mohammad-Ali Kiani
- Center of Excellence for pediatrics, Children's Medical Center, Tehran, Iran
| | - Ali Rabani
- Center of Excellence for pediatrics, Children's Medical Center, Tehran, Iran,Growth and Development research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Bahar Pakseresht
- Faculty of Pharmacy,Shahid Sadoughi University of Medical Sciences, Yazd, Iran
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36
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Kim JM, Choi JH, Lee JH, Kim GH, Lee BH, Kim HS, Shin JH, Shin CH, Kim CJ, Yu J, Lee DY, Cho WK, Suh BK, Lee JE, Chung HR, Yoo HW. High allele frequency of the p.Q258X mutation and identification of a novel mis-splicing mutation in the STAR gene in Korean patients with congenital lipoid adrenal hyperplasia. Eur J Endocrinol 2011; 165:771-8. [PMID: 21846663 DOI: 10.1530/eje-11-0597] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Steroidogenic acute regulatory (STAR) protein plays a crucial role in steroidogenesis, and mutations in the STAR gene cause congenital lipoid adrenal hyperplasia (CLAH). This study investigated the STAR mutation spectrum and functionally analyzed a novel STAR mutation in Korean patients with CLAH. METHODS Mutation analysis of STAR was carried out in 25 unrelated Korean CLAH patients. A region of STAR comprising exons 4-7 was cloned from human genomic DNA into an expression vector, followed by site-directed mutagenesis and transient expression in COS7 cells. The splicing pattern was analyzed by in vitro transcription, and each transcript was functionally characterized by measuring pregnenolone production in COS7 cells cotransfected with the cholesterol side chain cleavage system. RESULTS Mutation p.Q258X was identified in 46 of 50 alleles (92%); mutation c.653C>T was detected in two alleles (4%); and mutations p.R182H and c.745-6_810del were found in one allele (2%). Reverse transcriptase-PCR products amplified from a patient heterozygous for compound c.653C>T and c.745-6_810del mutation revealed multiple alternatively spliced mRNAs. In vitro expression analysis of a minigene consisting of exons 4-7 containing the c.653C>T yielded two transcripts in which exon 6 or exons 5 and 6 were skipped. The encoded proteins exhibited defective pregnenolone-producing ability. The c.745-6_810del mutation led to full and partial intron retention. CONCLUSIONS p.Q258X is the most common STAR mutation in Korea. A previously reported c.653C>T variant was found to cause aberrant splicing at the mRNA level, resulting in perturbation of STAR function. The c.745-6_810del mutation also resulted in aberrant splicing.
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Affiliation(s)
- Jae-Min Kim
- Division of Pediatric Endocrinology and Metabolism, Department of Pediatrics, Asan Medical Center Children's Hospital, University of Ulsan College of Medicine, 388-1, Pungnap-Dong, Songpa-Gu, Seoul 138-736, Republic of Korea
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Miller WL, Bose HS. Early steps in steroidogenesis: intracellular cholesterol trafficking. J Lipid Res 2011; 52:2111-2135. [PMID: 21976778 DOI: 10.1194/jlr.r016675] [Citation(s) in RCA: 361] [Impact Index Per Article: 27.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Steroid hormones are made from cholesterol, primarily derived from lipoproteins that enter cells via receptor-mediated endocytosis. In endo-lysosomes, cholesterol is released from cholesterol esters by lysosomal acid lipase (LAL; disordered in Wolman disease) and exported via Niemann-Pick type C (NPC) proteins (disordered in NPC disease). These diseases are characterized by accumulated cholesterol and cholesterol esters in most cell types. Mechanisms for trans-cytoplasmic cholesterol transport, membrane insertion, and retrieval from membranes are less clear. Cholesterol esters and "free" cholesterol are enzymatically interconverted in lipid droplets. Cholesterol transport to the cholesterol-poor outer mitochondrial membrane (OMM) appears to involve cholesterol transport proteins. Cytochrome P450scc (CYP11A1) then initiates steroidogenesis by converting cholesterol to pregnenolone on the inner mitochondrial membrane (IMM). Acute steroidogenic responses are regulated by cholesterol delivery from OMM to IMM, triggered by the steroidogenic acute regulatory protein (StAR). Chronic steroidogenic capacity is determined by CYP11A1 gene transcription. StAR mutations cause congenital lipoid adrenal hyperplasia, with absent steroidogenesis, potentially lethal salt loss, and 46,XY sex reversal. StAR mutations initially destroy most, but not all steroidogenesis; low levels of StAR-independent steroidogenesis are lost later due to cellular damage, explaining the clinical findings. Rare P450scc mutations cause a similar syndrome. This review addresses these early steps in steroid biosynthesis.
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Affiliation(s)
- Walter L Miller
- Department of Pediatrics, School of Medicine, University of California, San Francisco, CA 94143; UCSF Benioff Children's Hospital, San Francisco, CA 94143.
| | - Himangshu S Bose
- Department of Biochemistry, Mercer University School of Medicine, Savannah, GA 31404; and; Memorial University Medical Center, Savannah, GA 31404
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Abstract
Adequate functioning at all levels of the hypothalamic-pituitary-gonadal axis is necessary for normal gonadal development and subsequent sex steroid production. Deficiencies at any level of the axis can lead to a hypogonadal state. The causes of hypogonadism are heterogeneous and may involve any level of the reproductive system. This review discusses various causes of hypogonadism, describes the evaluation of hypogonadal states, and outlines treatment options for the induction of puberty in affected adolescents. Whereas some conditions are clearly delineated, the exact etiology and underlying pathogenesis of many disorders is unknown.
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Affiliation(s)
- Vidhya Viswanathan
- Section of Pediatric Endocrinology, Department of Pediatrics, Riley Hospital for Children, Indiana University School of Medicine, Room 5960, 702 Barnhill Drive, Indianapolis, IN 46202, USA.
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39
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Idkowiak J, O'Riordan S, Reisch N, Malunowicz EM, Collins F, Kerstens MN, Köhler B, Graul-Neumann LM, Szarras-Czapnik M, Dattani M, Silink M, Shackleton CHL, Maiter D, Krone N, Arlt W. Pubertal presentation in seven patients with congenital adrenal hyperplasia due to P450 oxidoreductase deficiency. J Clin Endocrinol Metab 2011; 96:E453-62. [PMID: 21190981 PMCID: PMC3124345 DOI: 10.1210/jc.2010-1607] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2010] [Accepted: 11/16/2010] [Indexed: 01/02/2023]
Abstract
CONTEXT P450 oxidoreductase (POR) is a crucial electron donor to all microsomal P450 cytochrome (CYP) enzymes including 17α-hydroxylase (CYP17A1), 21-hydroxylase (CYP21A2) and P450 aromatase. Mutant POR causes congenital adrenal hyperplasia with combined glucocorticoid and sex steroid deficiency. P450 oxidoreductase deficiency (ORD) commonly presents neonatally, with disordered sex development in both sexes, skeletal malformations, and glucocorticoid deficiency. OBJECTIVE The aim of the study was to describe the clinical and biochemical characteristics of ORD during puberty. DESIGN Clinical, biochemical, and genetic assessment of seven ORD patients (five females, two males) presenting during puberty was conducted. RESULTS Predominant findings in females were incomplete pubertal development (four of five) and large ovarian cysts (five of five) prone to spontaneous rupture, in some only resolving after combined treatment with estrogen/progestin, GnRH superagonists, and glucocorticoids. Pubertal development in the two boys was more mildly affected, with some spontaneous progression. Urinary steroid profiling revealed combined CYP17A1 and CYP21A2 deficiencies indicative of ORD in all patients; all but one failed to mount an appropriate cortisol response to ACTH stimulation indicative of adrenal insufficiency. Diagnosis of ORD was confirmed by direct sequencing, demonstrating disease-causing POR mutations. CONCLUSION Delayed and disordered puberty can be the first sign leading to a diagnosis of ORD. Appropriate testosterone production during puberty in affected boys but manifest primary hypogonadism in girls with ORD may indicate that testicular steroidogenesis is less dependent on POR than adrenal and ovarian steroidogenesis. Ovarian cysts in pubertal girls may be driven not only by high gonadotropins but possibly also by impaired CYP51A1-mediated production of meiosis-activating sterols due to mutant POR.
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Affiliation(s)
- Jan Idkowiak
- Centre for Endocrinology, Diabetes and Metabolism, School of Clinical and Experimental Medicine, University of Birmingham, Birmingham B15 2TT, United Kingdom
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Miller WL, Auchus RJ. The molecular biology, biochemistry, and physiology of human steroidogenesis and its disorders. Endocr Rev 2011; 32:81-151. [PMID: 21051590 PMCID: PMC3365799 DOI: 10.1210/er.2010-0013] [Citation(s) in RCA: 1432] [Impact Index Per Article: 110.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2010] [Accepted: 08/20/2010] [Indexed: 02/08/2023]
Abstract
Steroidogenesis entails processes by which cholesterol is converted to biologically active steroid hormones. Whereas most endocrine texts discuss adrenal, ovarian, testicular, placental, and other steroidogenic processes in a gland-specific fashion, steroidogenesis is better understood as a single process that is repeated in each gland with cell-type-specific variations on a single theme. Thus, understanding steroidogenesis is rooted in an understanding of the biochemistry of the various steroidogenic enzymes and cofactors and the genes that encode them. The first and rate-limiting step in steroidogenesis is the conversion of cholesterol to pregnenolone by a single enzyme, P450scc (CYP11A1), but this enzymatically complex step is subject to multiple regulatory mechanisms, yielding finely tuned quantitative regulation. Qualitative regulation determining the type of steroid to be produced is mediated by many enzymes and cofactors. Steroidogenic enzymes fall into two groups: cytochrome P450 enzymes and hydroxysteroid dehydrogenases. A cytochrome P450 may be either type 1 (in mitochondria) or type 2 (in endoplasmic reticulum), and a hydroxysteroid dehydrogenase may belong to either the aldo-keto reductase or short-chain dehydrogenase/reductase families. The activities of these enzymes are modulated by posttranslational modifications and by cofactors, especially electron-donating redox partners. The elucidation of the precise roles of these various enzymes and cofactors has been greatly facilitated by identifying the genetic bases of rare disorders of steroidogenesis. Some enzymes not principally involved in steroidogenesis may also catalyze extraglandular steroidogenesis, modulating the phenotype expected to result from some mutations. Understanding steroidogenesis is of fundamental importance to understanding disorders of sexual differentiation, reproduction, fertility, hypertension, obesity, and physiological homeostasis.
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Affiliation(s)
- Walter L Miller
- Distinguished Professor of Pediatrics, University of California San Francisco, San Francisco, California 94143-0978, USA.
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41
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Jehaimi CT, Araiza VC, Batish SD, Brosnan PG. Polycystic ovaries and adrenal insufficiency in a young pubescent female with lipoid congenital adrenal hyperplasia due to splice mutation of the StAR gene: a case report and review of the literature. J Pediatr Endocrinol Metab 2010; 23:1225-31. [PMID: 21714456 DOI: 10.1515/jpem.2010.196] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
We report a case of Lipoid Congenital Adrenal Hyperplasia (LCAH) secondary to Steroidogenic Acute Regulatory (StAR) gene mutation in an adolescent female with bilateral ovarian cysts. StAR gene defects follow an autosomal recessive mode of inheritance and typically present with severe adrenal insufficiency during infancy. Both sexes can be affected equally. XY males often present with sex reversal, while XX females may develop gonadal failure later in life due to premature loss of ovarian follicles. Recently there have been reported cases of successful fertility outcomes in women with LCAH. In our case report, we describe the clinical, biochemical and molecular analysis of a 16 year-old XX adolescent female who was suspected of having LCAH upon discovery of bilateral ovarian cysts in the context of adrenal insufficiency. Examination of the StAR gene revealed a homozygous splice site mutation. The patient is currently undergoing estradiol therapy to suppress ovarian cyst formation.
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Affiliation(s)
- Cayce T Jehaimi
- Department of Pediatrics, Division of Pediatric Endocrinology, University of Texas Health Science Center, Houston, TX, USA.
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42
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Sahakitrungruang T, Soccio RE, Lang-Muritano M, Walker JM, Achermann JC, Miller WL. Clinical, genetic, and functional characterization of four patients carrying partial loss-of-function mutations in the steroidogenic acute regulatory protein (StAR). J Clin Endocrinol Metab 2010; 95:3352-9. [PMID: 20444910 PMCID: PMC2928910 DOI: 10.1210/jc.2010-0437] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
CONTEXT Nonclassic congenital lipoid adrenal hyperplasia (lipoid CAH) is a recently recognized disorder caused by mutations in the steroidogenic acute regulatory protein (StAR) that retain partial function. Affected individuals can present with a phenotype of late onset adrenal insufficiency with only mild or minimally disordered sexual development. OBJECTIVES The aim was to delineate the clinical spectrum of StAR mutations and correlate phenotype with StAR activity. PATIENTS Four patients had nonclassic/atypical lipoid CAH. Adrenal insufficiency was manifested at birth in two patients and at 11 months and 4 yr in the other two. Three were 46,XY with underdeveloped genitalia. METHODS The StAR gene was sequenced, mutations were recreated in expression vectors, and StAR activity was measured as pregnenolone production in COS-1 cells cotransfected with the cholesterol side-chain cleavage system. StAR mutants were expressed as N-62 StAR in bacteria, and purified proteins were tested for activity with isolated steroidogenic mitochondria and for cholesterol-binding capacity. RESULTS DNA sequencing identified mutations on all alleles. Missense mutations were R188C, G221D, L260P, and F267S; we also tested R192C described by others. The respective activities of R188C, R192C, G221D, L260P, and F267S were 8.0, 39.4, 2.4, 3.1, and 6.1% of wild-type in transfected cells, and 12.8, 54.8, 6.3, 1.8, and 9.5% with isolated mitochondria. Cholesterol binding capacities of R188C, R192C, G221D, L260P, and F267S were 6.7, 55.3, 10.2, 4.6, and 20.9%. These data are correlated to the three-dimensional structure of StAR. CONCLUSIONS There is a broad clinical spectrum of StAR mutations; StAR activities in vitro correlate well with clinical phenotypes.
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Affiliation(s)
- Taninee Sahakitrungruang
- Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, 10330 Bangkok, Thailand. [corrected]
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Bens S, Mohn A, Yüksel B, Kulle AE, Michalek M, Chiarelli F, Nuri Ozbek M, Leuschner I, Grötzinger J, Holterhus PM, Riepe FG. Congenital lipoid adrenal hyperplasia: functional characterization of three novel mutations in the STAR gene. J Clin Endocrinol Metab 2010; 95:1301-8. [PMID: 20080861 DOI: 10.1210/jc.2009-1176] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
CONTEXT The steroidogenic acute regulatory protein (StAR) has been shown to be essential for steroidogenesis by mediating cholesterol transfer into mitochondria. Inactivating StAR mutations cause the typical clinical picture of congenital lipoid adrenal hyperplasia. OBJECTIVE The objective of the investigation was to study the functional and structural consequences of three novel StAR mutations (p.N148K in an Italian patient; p.P129fs and p.Q128R in a Turkish patient). METHODS AND RESULTS Transient in vitro expression of the mutant proteins together with P450 side-chain cleavage enzyme, adrenodoxin, and adrenodoxin reductase yielded severely diminished cholesterol conversion of the p.N148K mutant, the combined p.P129fs and p.Q128R mutant, and the p.P129fs mutant by itself. The p.Q128R mutant led to a higher cholesterol conversion than the wild-type StAR protein. As derived from three-dimensional protein modeling, the residue N148 is lining the ligand cavity of StAR. A positively charged lysine residue at position 148 disturbs the hydrophobic cluster formed by the alpha4-helix and the sterol binding pocket. The frame shift mutation p.P129fs truncates the StAR protein. Residue p.Q128 is situated at the surface of the molecule and is not part of any functionally characterized region of the protein. CONCLUSION The mutations p.N148K and p.P129fs cause adrenal insufficiency in both cases and lead to a disorder of sex development with complete sex reversal in the 46, XY case. The mutation p.Q128R, which is not relevant for the patient's phenotype, is the first reported variant showing a gain of function. We speculate that the substitution of hydrophilic glutamine with basic arginine at the surface of the molecule may accelerate cholesterol transfer.
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Affiliation(s)
- Susanne Bens
- Division of Pediatric Endocrinology, Department of Pediatrics, University Hospital Schleswig- Holstein, Schwanenweg 20, D-24105 Kiel, Germany
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Ramayya MS, Sheng M, Moroz K, Hill SM, Rowan BG. Human steroidogenic factor-1 (hSF-1) regulates progesterone biosynthesis and growth of ovarian surface epithelial cancer cells. J Steroid Biochem Mol Biol 2010; 119:14-25. [PMID: 20045459 DOI: 10.1016/j.jsbmb.2009.11.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2009] [Revised: 11/09/2009] [Accepted: 11/12/2009] [Indexed: 11/21/2022]
Abstract
The majority of cancers derived from ovarian surface epithelial (OSE) cells are lethal. Estrogens promote proliferation of OSE cells, whereas progesterone inhibits proliferation and promotes apoptosis of OSE cells. Human steroidogenic factor-1 (hSF-1) induction of the steroidogenic acute regulatory protein (StAR) gene, and the steroidogenic enzymes CYP11A1 and HSD3B2 is central to progesterone biosynthesis. Whereas hSF-1 and StAR are expressed in human ovarian surface epithelial (HOSE) cells, hSF-1 and StAR protein were not expressed in a panel of malignant ovarian cancer cell lines (SKOV-3, BG-1, and Caov-3), and in human OSE cells immortalized by SV40 large T antigen (IOSE-121). Transient expression of hSF-1 in SKOV-3 cells activated the expression of StAR, p450scc and 3betaHSD-II mRNAs, and induced progesterone biosynthesis. Additionally, hSF-1 suppressed proliferation and promoted apoptosis of SKOV-3 cells and suppressed SKOV-3 cell growth induced by ERalpha and estradiol. These findings suggest that hSF-1 is central to progesterone biosynthesis in OSE cells. Human SF-1 may decrease OSE cancer cell numbers directly by apoptosis, and indirectly by opposing estradiol-induced proliferation. These findings are consistent with the hypothesis, that down-regulation of hSF-1 contributes to progression of ovarian epithelial cancers.
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Affiliation(s)
- M S Ramayya
- Section of Pediatric Endocrinology, Department of Pediatrics, Tulane University School of Medicine, New Orleans, LA 70112, USA.
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45
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Abstract
Adequate functioning at all levels of the hypothalamic-pituitary-gonadal axis is necessary for normal gonadal development and subsequent sex steroid production. Deficiencies at any level of the axis can lead to a hypogonadal state. The causes of hypogonadism are heterogeneous and may involve any level of the reproductive system. This review discusses various causes of hypogonadism, describes the evaluation of hypogonadal states, and outlines treatment options for the induction of puberty in affected adolescents. Whereas some conditions are clearly delineated, the exact etiology and underlying pathogenesis of many disorders is unknown.
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Affiliation(s)
- Vidhya Viswanathan
- Department of Pediatrics, Riley Hospital for Children, Indiana University School of Medicine, Indianapolis, 46202, USA.
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Metherell LA, Naville D, Halaby G, Begeot M, Huebner A, Nürnberg G, Nürnberg P, Green J, Tomlinson JW, Krone NP, Lin L, Racine M, Berney DM, Achermann JC, Arlt W, Clark AJL. Nonclassic lipoid congenital adrenal hyperplasia masquerading as familial glucocorticoid deficiency. J Clin Endocrinol Metab 2009; 94:3865-71. [PMID: 19773404 PMCID: PMC2860769 DOI: 10.1210/jc.2009-0467] [Citation(s) in RCA: 100] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
CONTEXT Familial glucocorticoid deficiency (FGD) is an autosomal recessive disorder resulting from resistance to the action of ACTH on the adrenal cortex. Affected individuals are deficient in cortisol and, if untreated, are likely to succumb to hypoglycemia and/or overwhelming infection. Mutations of the ACTH receptor (MC2R) and the melanocortin 2 receptor accessory protein (MRAP), FGD types 1 and 2 respectively, account for approximately 45% of cases. OBJECTIVE A locus on chromosome 8 has previously been linked to the disease in three families, but no underlying gene defect has to date been identified. DESIGN The study design comprised single-nucleotide polymorphism genotyping and mutation detection. SETTING The study was conducted at secondary and tertiary referral centers. PATIENTS Eighty probands from families referred for investigation of the genetic cause of FGD participated in the study. INTERVENTIONS There were no interventions. RESULTS Analysis by single-nucleotide polymorphism array of the genotype of one individual with FGD previously linked to chromosome 8 revealed a large region of homozygosity encompassing the steroidogenic acute regulatory protein gene, STAR. We identified homozygous STAR mutations in this patient and his affected siblings. Screening of our total FGD patient cohort revealed homozygous STAR mutations in a further nine individuals from four other families. CONCLUSIONS Mutations in STAR usually cause lipoid congenital adrenal hyperplasia, a disorder characterized by both gonadal and adrenal steroid deficiency. Our results demonstrate that certain mutations in STAR (R192C and the previously reported R188C) can present with a phenotype indistinguishable from that seen in FGD.
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Affiliation(s)
- Louise A Metherell
- Centre for Endocrinology, William Harvey Research Institute, Barts and the London School of Medicine, London EC1M 6BQ, United Kingdom.
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47
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Khoury K, Barbar E, Ainmelk Y, Ouellet A, Lehoux JG. Gonadal function, first cases of pregnancy, and child delivery in a woman with lipoid congenital adrenal hyperplasia. J Clin Endocrinol Metab 2009; 94:1333-7. [PMID: 19158201 DOI: 10.1210/jc.2008-1694] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
CONTEXT Mutations in the steroidogenic acute regulatory protein (StAR) gene often cause lipoid congenital adrenal hyperplasia (LCAH). In this disorder an impairment of steroid synthesis leads to adrenal and gonadal insufficiencies with a particular female genital phenotype in both human karyotypes. Pregnancy in LCAH has not been yet reported. OBJECTIVE We describe the first cases of pregnancy in a LCAH female patient bearing the L275P mutation in the StAR gene. DESIGN We studied the gonadal function, pubertal development, and apply the appropriate hormonal therapy to support pregnancies. PATIENT A 46,xx patient of French Canadian descent was diagnosed with LCAH at the age of 4.5 months. Substitution therapy with glucocorticoids and mineralocorticoids led to normal growth and development. Progressive pubertal development started at the age of 11 7/12 yr. Menarche occurred at 14 2/12 yr with normal regular menstruations thereafter but without ovulation. RESULTS Clomiphene stimulation induced the first pregnancy at 25 4/12 yr of age. Spontaneous abortion occurred after 6 wk gestation. The second pregnancy (with clomiphene stimulation) was induced at the age of 26 yr. Progesterone (Prog) therapy was added at the 17th day of the cycle to protect pregnancy. Vaginal delivery of dichorionic-diamniotic twin pregnancy occurred at 30 wk gestation (two normal weight male babies). Two years later, again under clomiphene stimulation, she underwent another successful singleton pregnancy and delivered a normal weight female baby at 36 wk. The pregnancies were almost uncomplicated. CONCLUSION Despite the dysfunctional StAR, pregnancy is possible under the proper therapeutic strategy.
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Affiliation(s)
- Khalil Khoury
- Departments of Pediatrics, Faculty of Medicine, University of Sherbrooke, Sherbrooke, Quebec, Canada
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Kaku U, Kameyama K, Izawa M, Yamada M, Miyamoto J, Suzuki T, Sasano H, Hasegawa Y. Ovarian histological findings in an adult patient with the steroidogenic acute regulatory protein (StAR) deficiency reveal the impairment of steroidogenesis by lipoid deposition. Endocr J 2008; 55:1043-9. [PMID: 18724044 DOI: 10.1507/endocrj.k08e-102] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
CONTEXT The steroidogenic acute regulatory protein (StAR) is essential for the production of steroid hormones. The mutations in the StAR gene typically cause congenital lipoid adrenal hyperplasia (lipoid CAH), characterized by severe adrenal insufficiency in both sexes and complete female external genitalia in genetic males. Affected 46, XX females feminize at puberty and menstruate but have progressive hypergonadotropic hypogonadism. It has been hypothesized that the cholesterol accumulation in the steroidogenic cells destroys the residual steroidogenic capacity and progressive ovarian failure occurs (two-hit model). Additionally, ovulation and luteinization in the patients is supposed to be impaired. However, those hypotheses have not been confirmed histologically. OBJECTIVE We examined whether pathological findings of the ovary in a patient of lipoid CAH corresponded with two-hit model, and whether ovulation and luteinization occurred or not in the patient. SUBJECT The ovary in an adult 46, XX female with a homozygous nonsense mutation (Q258X) in the StAR gene was examined. When the patient was age 22 yr, the ovary was resected because of enlargement with polycysts and subsequent torsion. RESULT The affected ovary demonstrated remarkable lipoid deposition and changes of the mitochondrial ultrastructure. Immunohistochemical examination showed decrease of steroidogenic enzymes such as P450 cholesterol side-chain cleavage (P450scc). Additionally, we detected corpus albicans in the affected ovary. CONCLUSION This is the first detailed report on ovarian histology in an adult 46, XX female with a null type mutation of the StAR gene (Q258X), which indicates the evidence of the impairment of ovarian StAR-independent steroidogenesis by lipoid deposition.
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Affiliation(s)
- Uiko Kaku
- Department of Endocrinology and Metabolism, Tokyo Metropolitan Kiyose Children's Hospital, Kiyose, Tokyo, Japan
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Sertedaki A, Pantos K, Vrettou C, Kokkali G, Christofidou C, Kanavakis E, Dacou-Voutetakis C. Conception and pregnancy outcome in a patient with 11-bp deletion of the steroidogenic acute regulatory protein gene. Fertil Steril 2008; 91:934.e15-8. [PMID: 18829024 DOI: 10.1016/j.fertnstert.2008.07.1770] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2008] [Revised: 07/21/2008] [Accepted: 07/25/2008] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To report the pregnancy outcome of a patient with congenital lipoid adrenal hyperplasia (CLAH) due to an 11-bp deletion of the steroidogenic acute regulatory protein (StAR) gene. DESIGN Case report. SETTING University-based pediatric endocrinology unit and private IVF clinic. PATIENT(S) A 24-year-old woman homozygous for a StAR gene deletion, married to a man heterozygous for the same molecular defect. INTERVENTION(S) Ovarian stimulation, oocyte retrieval followed by IVF, blastomere biopsy, preimplantation genetic diagnosis, and additional estrogen support until placental function initiation. MAIN OUTCOME MEASURE(S) Normal pregnancy outcome and delivery of a healthy newborn. RESULT(S) A female patient with CLAH gave birth to a normal newborn after IVF and preimplantation genetic diagnosis. CONCLUSION(S) Pregnancy is feasible in patients with StAR gene mutations, provided that extra estrogens are offered until placental function ensues.
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Affiliation(s)
- Amalia Sertedaki
- First Department of Pediatrics, Medical School, Athens University, Athens, Greece
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50
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Ishizu K, Tsubaki J, Jyo W, Tajima T. A Novel Mutation of the Steroidogenic Acute Regulatory Protein (StAR) Gene in a Japanese Patient with Congenital Lipoid Adrenal Hyperplasia. Clin Pediatr Endocrinol 2008; 17:23-5. [PMID: 24790358 PMCID: PMC4004877 DOI: 10.1297/cpe.17.23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2007] [Accepted: 10/04/2007] [Indexed: 11/22/2022] Open
Affiliation(s)
- Katsura Ishizu
- Department of Pediatrics, Hokkaido University School of Medicine
| | - Junko Tsubaki
- Department of Pediatrics, Hokkaido University School of Medicine
| | - Wakako Jyo
- Department of Pediatrics, Hokkaido University School of Medicine
| | - Toshihiro Tajima
- Department of Pediatrics, Hokkaido University School of Medicine
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