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Koren I, Weintrob N, Kebesch R, Majdoub H, Stein N, Naor S, Segev-Becker A. Genotype-Specific Cortisol Reserve in a Cohort of Subjects With Nonclassic Congenital Adrenal Hyperplasia (NCCAH). J Clin Endocrinol Metab 2024; 109:852-857. [PMID: 37715965 DOI: 10.1210/clinem/dgad546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2023] [Revised: 08/22/2023] [Accepted: 09/15/2023] [Indexed: 09/18/2023]
Abstract
CONTEXT Recent guidelines suggest that patients with nonclassic congenital adrenal hyperplasia (NCCAH) stop glucocorticoid therapy after achieving adult height. However, these guidelines do not differentiate between NCCAH genotype groups. OBJECTIVE Compare ACTH-stimulated cortisol and 17-hydroxyprogesterone (17OHP) levels, and the rate of partial cortisol insufficiency in subjects with NCCAH carrying one mild and one severe (mild/severe) mutation vs subjects with biallelic mild (mild/mild) mutations. METHODS Retrospective evaluation of the medical records of 122 patients who presented with postnatal virilization and were diagnosed with NCCAH. Patients underwent standard intravenous 0.25 mg/m2 ACTH stimulation testing. Those with stimulated 17OHP level ≥40 nmol/L were screened for the 9 most frequent CYP21A2 gene mutations followed by multiplex ligation-dependent probe amplification. A stimulated cortisol level below 500 nmol/L was defined as partial cortisol deficiency. RESULTS Patients were subdivided into 3 genotype groups: 77 carried the mild/mild genotype, mainly homozygous for p.V281L mutation; 29 were compound heterozygous for mild/severe mutation, mainly p.V281L/p.I2Splice, and 16 were heterozygous for p.V281L, and were excluded from statistical evaluation. Stimulated cortisol levels were significantly lower in the mild/severe than in the mild/mild group (mean ± SD, 480 ± 90 vs 570 ± 125 nmol/L, P < .001). The mild/severe group exhibited a significantly higher rate of partial cortisol insufficiency (21/28, 75% vs 28/71, 39%, P = .004). Peak 17OHP was significantly higher in the mild/severe group (198 ± 92 vs 118 ± 50 nmol/L, P < .001). CONCLUSION The high rate of partial adrenal insufficiency in the mild/severe group underscores the need to carefully consider the value of glucocorticoid therapy cessation and the importance of stress coverage in this group.
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Affiliation(s)
- Ilana Koren
- Pediatric Endocrinology Unit, Carmel Medical Center, Clalit Health Services, Haifa 3436212, Israel
- Faculty of Medicine, Technion-Israel Institute of Technology, Haifa 3200003, Israel
| | - Naomi Weintrob
- Pediatric Endocrinology and Diabetes Unit, Dana-Dwek Children's Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv 6423906, Israel
| | - Rebekka Kebesch
- Pediatric Endocrinology Unit, Carmel Medical Center, Clalit Health Services, Haifa 3436212, Israel
| | - Hussein Majdoub
- Pediatric Endocrinology Unit, Carmel Medical Center, Clalit Health Services, Haifa 3436212, Israel
| | - Nili Stein
- Statistics Unit, Carmel Medical Center, Clalit Health Services, Haifa 3436212, Israel
| | - Shulamit Naor
- Endocrine laboratory, Clalit Health Services, Haifa 3688847, Israel
| | - Anat Segev-Becker
- Pediatric Endocrinology and Diabetes Unit, Dana-Dwek Children's Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv 6423906, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
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Soares-Jr. JM, Hayashida SAY, Marcondes JAM, Maciel GAR, Barcellos CRG, Maffazioli GDN, Monteiro KKAC, Turri JAO, Azziz R, Baracat EC. Influence of Phenotypes on the Metabolic Syndrome of Women with Polycystic Ovary Syndrome over a Six-Year Follow-Up in Brazil. Biomedicines 2023; 11:3262. [PMID: 38137483 PMCID: PMC10741024 DOI: 10.3390/biomedicines11123262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 11/24/2023] [Accepted: 12/04/2023] [Indexed: 12/24/2023] Open
Abstract
BACKGROUND We followed polycystic ovary syndrome (PCOS) women with metabolic syndrome (MS) over a six-year treatment period and evaluated the influence of PCOS phenotypes on MS and on the risk for type 2 diabetes mellitus (T2DM). METHODS This was an observational study of 457 PCOS women, whose demographic, clinical, hormonal, and metabolic data underwent analysis. The PCOS women were divided into four groups per NIH recommendations. RESULTS After a follow-up of a mean of six years (1-20 years), 310 patients were selected to assess the development of T2DM and MS. The clinical and biochemical parameters, along with the Rotterdam phenotypes, were evaluated. Data were analyzed using Student's t- and the Pearson chi-square tests for data variation and group proportions, respectively. Additionally, multivariate analysis was applied to evaluate the effect of PCOS phenotypes on the risk for MS and T2DM. Patients of the four PCOS phenotypes did not differ in age, body mass index, total testosterone, insulin resistance, and dyslipidemia, but phenotype A patients showed the highest risk for T2DM. A decrease in androgen levels was not followed by an improved metabolic profile; instead, there was a significant increase in the number of T2DM cases. CONCLUSION Phenotype A women are at the highest risk for type 2 diabetes mellitus.
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Affiliation(s)
- Jose Maria Soares-Jr.
- Laboratório de Ginecologia Estrutural e Molecular (LIM-58), Disciplina de Ginecologia, Departamento de Obstetrícia e Ginecologia, Hospital das Clínicas HC-FMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo 05403-010, Brazil; (S.A.Y.H.); (G.A.R.M.); (G.D.N.M.); (K.K.A.C.M.); (J.A.O.T.); (E.C.B.)
| | - Sylvia Asaka Yamashita Hayashida
- Laboratório de Ginecologia Estrutural e Molecular (LIM-58), Disciplina de Ginecologia, Departamento de Obstetrícia e Ginecologia, Hospital das Clínicas HC-FMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo 05403-010, Brazil; (S.A.Y.H.); (G.A.R.M.); (G.D.N.M.); (K.K.A.C.M.); (J.A.O.T.); (E.C.B.)
| | - Jose Antonio Miguel Marcondes
- Divisão de Endocrinologia, Hospital das Clínicas HC-FMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo 05403-010, Brazil; (J.A.M.M.); (C.R.G.B.)
| | - Gustavo Arantes Rosa Maciel
- Laboratório de Ginecologia Estrutural e Molecular (LIM-58), Disciplina de Ginecologia, Departamento de Obstetrícia e Ginecologia, Hospital das Clínicas HC-FMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo 05403-010, Brazil; (S.A.Y.H.); (G.A.R.M.); (G.D.N.M.); (K.K.A.C.M.); (J.A.O.T.); (E.C.B.)
| | - Cristiano Roberto Grimaldi Barcellos
- Divisão de Endocrinologia, Hospital das Clínicas HC-FMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo 05403-010, Brazil; (J.A.M.M.); (C.R.G.B.)
| | - Giovana De Nardo Maffazioli
- Laboratório de Ginecologia Estrutural e Molecular (LIM-58), Disciplina de Ginecologia, Departamento de Obstetrícia e Ginecologia, Hospital das Clínicas HC-FMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo 05403-010, Brazil; (S.A.Y.H.); (G.A.R.M.); (G.D.N.M.); (K.K.A.C.M.); (J.A.O.T.); (E.C.B.)
| | - Karla Krislaine Alves Costa Monteiro
- Laboratório de Ginecologia Estrutural e Molecular (LIM-58), Disciplina de Ginecologia, Departamento de Obstetrícia e Ginecologia, Hospital das Clínicas HC-FMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo 05403-010, Brazil; (S.A.Y.H.); (G.A.R.M.); (G.D.N.M.); (K.K.A.C.M.); (J.A.O.T.); (E.C.B.)
| | - Jose Antonio Orellana Turri
- Laboratório de Ginecologia Estrutural e Molecular (LIM-58), Disciplina de Ginecologia, Departamento de Obstetrícia e Ginecologia, Hospital das Clínicas HC-FMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo 05403-010, Brazil; (S.A.Y.H.); (G.A.R.M.); (G.D.N.M.); (K.K.A.C.M.); (J.A.O.T.); (E.C.B.)
| | - Ricardo Azziz
- Academic Health and Hospital Affairs, The State University of New York (SUNY) System Adminstration, Buffalo, NY 14261, USA;
| | - Edmund Chada Baracat
- Laboratório de Ginecologia Estrutural e Molecular (LIM-58), Disciplina de Ginecologia, Departamento de Obstetrícia e Ginecologia, Hospital das Clínicas HC-FMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo 05403-010, Brazil; (S.A.Y.H.); (G.A.R.M.); (G.D.N.M.); (K.K.A.C.M.); (J.A.O.T.); (E.C.B.)
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