Rare hypertension as a result of 17alpha-hydroxylase deficiency

Congenital adrenal hyperplasia causing hypertension: an illustrative review

Congenital adrenal hyperplasia (CAH) is often considered a pediatric endocrinology condition, but we present two cases of young adults who presented with hypertension. An 18-year-old woman was found to have hypertension and hypokalemia when she presented for gonadectomy for 46, XY gonadal dysgenesis. She was subsequently found to have low cortisol, elevated progesterone, and elevated aldosterone. Genetic testing confirmed 17-alpha hydroxylase deficiency (17OHD). Her case was unique in that 17OHD usually presents with hypoaldosteronism. We also present the case of a 15-year-old man (46, XX) with resistant hypertension due to 11-beta hydroxylase deficiency (11OHD) who underwent bilateral adrenalectomy for control of hypertension. The relevant literature is reviewed including the pathophysiology, clinical presentation, and treatment of the hypertensive variants of congenital adrenal hyperplasia. We also review the unique areas of hyperaldosteronism in 17OHD and the use of bilateral adrenalectomy for control of hypertension in CAH.

The relationship between the polymorphisms of the CYP17A1 gene and hypertension: A meta-analysis

OBJECTIVE

With the development of genome-wide association studies (GWAS) concerning hypertension, a growing number of susceptibility genes related to hypertension have been revealed. Subsequently, several studies have investigated the association between CYP17A1 rs1004467 heritable variation and hypertension; however, the results have been inconsistent. In this study, a meta-analysis was performed to assess the association between the CYP17A1 rs1004467 polymorphism and hypertension risk.

METHODS

The PubMed, ISI Web of Science and Embase databases as well as China Wanfang, Weipu and the Chinese Journal Full-text Database were used to retrieve all publications from 2005 to 2013 related to case-control studies that reported a link between the risk factors for hypertension and the CYP17A1 polymorphism. All association studies were identified, and a meta-analysis was conducted using the RevMan 5.0 estimate for odds ratios (ORs) to determine whether the A allele predicts hypertension outcomes.

RESULTS

Three articles including five studies (totaling 4495 patients and 3529 controls) were identified. The overall effect suggested that rs1004467 was significantly associated with hypertension (OR=1.22, 95%CI 1.08-1.38, p=0.001).

CONCLUSIONS

The present meta-analysis confirmed the significant association between a polymorphism of the CYP17A1 gene and hypertension susceptibility. The CYP17A1 A allele should be considered a risk factor for hypertension.