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Siklar Z, Camtosun E, Bolu S, Yildiz M, Akinci A, Bas F, Dündar İ, Bestas A, Ünal E, Kocaay P, Guran T, Buyukyilmaz G, Ugurlu AK, Tosun BG, Turan I, Kurnaz E, Yuksel B, Turkkahraman D, Cayir A, Celmeli G, Gonc EN, Eklioğlu BS, Cetinkaya S, Yilmaz SK, Atabek ME, Buyukinan M, Arslan E, Mengen E, Cakir EDP, Karaoglan M, Hatipoglu N, Orbak Z, Ucar A, Akyurek N, Akbas ED, Isik E, Kaygusuz SB, Sutcu ZK, Seymen G, Berberoglu M. 17α Hydroxylase/17,20 lyase deficiency: clinical features and genetic insights from a large Turkey cohort. Endocrine 2024; 85:1407-1416. [PMID: 39020240 DOI: 10.1007/s12020-024-03962-6] [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: 05/18/2024] [Accepted: 07/08/2024] [Indexed: 07/19/2024]
Abstract
PURPOSE 17α Hydroxylase/17,20 lyase deficiency (17OHD) is a rare form of congenital adrenal hyperplasia, typically diagnosed in late adolescence with symptoms of pubertal delay and hypertension. This study aimed to determine the clinical and laboratory characteristics of 17OHD cases and gather data on disease management. METHODS Data from 97 nationwide cases were analyzed using the CEDD-NET web system. Diagnostic, follow-up findings, and final heights of patients were evaluated. RESULTS Mean age at admission was 13.54 ± 4.71 years, with delayed puberty as the most common complaint. Hypertension was detected in 65% at presentation; hypokalemia was present in 34%. Genetic analysis revealed Exon 1-6 homozygous deletion as the most frequent mutation, identified in 42 cases. Hydrocortisone replacement was universal; pubertal replacement was administered to 66 cases. Antihypertensive treatment was required in 57 (90%) patients. Thirty-seven cases reached final height, with an average SD of 0.015 in 46,XX and -1.43 in 46,XY. Thelarche and pubarche did not develop properly in some cases despite estradiol treatment. CONCLUSION This study represents the largest cohort of pediatric cases of 17-hydroxylase deficiency (17OHD) documented in the literature. Hypertension and hypokalemia can serve as guiding indicators for early diagnosis.The final height is typically considered to be normal. The relationship between genotype and phenotype remains elusive. The initial genetic test for exon 1-6 deletions may be MLPA in our region.
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Affiliation(s)
- Zeynep Siklar
- Ankara University Faculty of Medicine, Department of Pediatric Endocrinology, Ankara, Türkiye
| | - Emine Camtosun
- Inonu University Faculty of Medicine, Department of Pediatric Endocrinology and Diabetes, Malatya, Türkiye
| | - Semih Bolu
- Bolu Abant Izzet Baysal University Faculty of Medicine, Department of Pediatric Endocrinology, Bolu, Türkiye
| | - Melek Yildiz
- Istanbul University Faculty of Medicine, Department of Pediatric Endocrinology, Istanbul, Türkiye
| | - Aysehan Akinci
- Inonu University Faculty of Medicine, Department of Pediatric Endocrinology and Diabetes, Malatya, Türkiye
| | - Firdevs Bas
- Istanbul University Faculty of Medicine, Department of Pediatric Endocrinology, Istanbul, Türkiye
| | - İsmail Dündar
- Inonu University Faculty of Medicine, Department of Pediatric Endocrinology and Diabetes, Malatya, Türkiye
| | - Asli Bestas
- Dicle University Faculty of Medicine, Department of Pediatric Endocrinology, Diyarbakır, Türkiye
| | - Edip Ünal
- Dicle University Faculty of Medicine, Department of Pediatric Endocrinology, Diyarbakır, Türkiye
| | - Pinar Kocaay
- Ankara Bilkent City Hospital, Clinic of Pediatric Endocrinology, Ankara, Türkiye
| | - Tulay Guran
- Marmara University Faculty of Medicine, Department of Pediatric Endocrinology and Diabetes, Istanbul, Türkiye
| | - Gonul Buyukyilmaz
- Ankara Bilkent City Hospital, Clinic of Pediatric Endocrinology, Ankara, Türkiye
| | - Aylin Kilinc Ugurlu
- Ankara Bilkent City Hospital, Clinic of Pediatric Endocrinology, Ankara, Türkiye.
| | - Buşra Gurpinar Tosun
- Marmara University Faculty of Medicine, Department of Pediatric Endocrinology and Diabetes, Istanbul, Türkiye
| | - Ihsan Turan
- Cukurova University Faculty of Medicine, Department of Pediatric Endocrinology, Adana, Türkiye
| | - Erdal Kurnaz
- Ankara Etlik City Hospital, Clinic of Pediatric Endocrinology, Ankara, Türkiye
| | - Bilgin Yuksel
- Cukurova University Faculty of Medicine, Department of Pediatric Endocrinology, Adana, Türkiye
| | - Doga Turkkahraman
- University of Health Sciences, Antalya Training and Resarch Hospital, Clinic of Pediatric Endocrinology, Antalya, Türkiye
| | - Atilla Cayir
- University of Health Sciences, Erzurum Training and Resarch Hospital, Clinic of Pediatric Endocrinology and Diabetes, Erzurum, Turkey
| | - Gamze Celmeli
- University of Health Sciences, Antalya Training and Resarch Hospital, Clinic of Pediatric Endocrinology, Antalya, Türkiye
| | - E Nazli Gonc
- Hacettepe University Faculty of Medicine, İhsan Doğramacı Children's Hospital, Department of Pediatric Endocrinology, Ankara, Türkiye
| | - Beray Selver Eklioğlu
- Necmettin Erbakan University Faculty of Medicine, Department of Pediatric Endocrinology, Konya, Türkiye
| | - Semra Cetinkaya
- University of Health Sciences, Dr Sami Ulus Child Health and Diseases Training and Research Hospital, Clinic of Pediatric Endocrinology, Ankara, Türkiye
| | - Seniha Kiremitci Yilmaz
- University of Health Sciences, Haseki Training and Research Hospital, Clinic of Pediatric Endocrinology, Istanbul, Türkiye
| | - Mehmet Emre Atabek
- Necmettin Erbakan University Faculty of Medicine, Department of Pediatric Endocrinology, Konya, Türkiye
| | - Muammer Buyukinan
- Selcuk University Faculty of Medicine, Department of Pediatric Endocrinology, Konya, Türkiye
| | - Emrullah Arslan
- Ege University Faculty of Medicine, Department of Pediatric Endocrinology and Diabetes, Izmir, Türkiye
| | - Eda Mengen
- Ankara Training and Research Hospital, Ankara, Türkiye
| | - Esra Deniz Papatya Cakir
- University of Health Sciences, Bakirkoy Dr. Sadi Konuk Training and Resarch Hospital, Clinic of Pediatric Endocrinology, Istanbul, Türkiye
| | - Murat Karaoglan
- Gaziantep University Faculty of Medicine,, Department of Pediatric Endocrinology, Gaziantep, Türkiye
| | - Nihal Hatipoglu
- Erciyes University Faculty of Medicine, Department of Pediatric Endocrinology, Kayseri, Türkiye
| | - Zerrin Orbak
- Ataturk University Faculty of Medicine, Department of Pediatric Endocrinology and Diabetes, Erzurum, Türkiye
| | - Ahmet Ucar
- University of Health Sciences, Şişli Hamidiye Etfal Training and Resarch Hospital, Clinic of Pediatric Endocrinology, İstanbul, Türkiye
| | - Nesibe Akyurek
- Baskent University Faculty of Medicine, Department of Pediatric Endocrinology, Konya, Türkiye
| | | | - Emregül Isik
- Gaziantep Children's Hospital, Gaziantep, Türkiye
| | | | - Zumrut Kocabey Sutcu
- Basaksehir Cam and Sakura City Hospital, Clinic of Pediatric Endocrinology, İstanbul, Türkiye
| | - Gulcan Seymen
- University of Health Sciences, Umraniye Training and Research Hospital, Clinic of Pediatric Endocrinology, İstanbul, Türkiye
| | - Merih Berberoglu
- Ankara University Faculty of Medicine, Department of Pediatric Endocrinology, Ankara, Türkiye
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Maekawa K, Shimizu Y, Hayashi K, Hatano S, Miyauchi Y, Sakurai T, Mitsumori K, Onishi H. Seminoma in a 46, XY patient with 17α-hydroxylase deficiency. IJU Case Rep 2024; 7:329-332. [PMID: 38966769 PMCID: PMC11221934 DOI: 10.1002/iju5.12737] [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: 02/20/2024] [Accepted: 05/12/2024] [Indexed: 07/06/2024] Open
Abstract
Introduction 17α-Hydroxylase deficiency is a very rare disease reported to be associated with a risk of gonadal malignancy. We herein report a rare case of seminoma in a 46, XY patient with 17α-hydroxylase deficiency. Case presentation A 52-year-old woman presented with a 9-cm pelvic tumor. At age 14, she had been identified as having the XY karyotype and 17α-hydroxylase deficiency. However, she was not informed and did not consult the urology department. Laparoscopic gonadectomy was performed at the latest consultation, and seminoma was diagnosed. Conclusion This is the third reported case of testicular tumor and the first of germ cell tumor in a 46, XY patient with 17α-hydroxylase deficiency. Given the rarity and the risk of gonadal malignancy associated with 17α-hydroxylase deficiency, the involvement of multidisciplinary specialists and prophylactic gonadectomy is considered crucial in its management.
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Affiliation(s)
- Ken Maekawa
- Department of UrologyOsaka Red Cross HospitalOsakaJapan
| | | | - Koken Hayashi
- Department of UrologyOsaka Red Cross HospitalOsakaJapan
| | | | | | - Takaki Sakurai
- Department of PathologyOsaka Red Cross HospitalOsakaJapan
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Liao Q, Shen R, Liao M, Ran C, Zhou L, Zhang Y, Peng G, Sun Z, Zheng H, Long M. An Asian case of combined 17α-hydroxylase/17,20-lyase deficiency due to homozygous p.R96Q mutation: A case report and review of the literature. Front Endocrinol (Lausanne) 2022; 13:989447. [PMID: 36339422 PMCID: PMC9627194 DOI: 10.3389/fendo.2022.989447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Accepted: 09/26/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Combined 17α-hydroxylase/17,20-lyase deficiency (17-OHD) is a very rare form of congenital adrenal hyperplasia (CAH) caused by mutations in the CYP17A1 gene. Almost 100 different mutations of the CYP17A1 gene have been reported, including p.R96Q mutation, but no case of p.R96Q mutation has been described in Asian populations. CASE PRESENTATION We describe a 22-year-old female patient of 46,XY karyotype, who presented with pseudohermaphrodism, primary amenorrhea, underdeveloped secondary sexual characteristics, delayed epiphyseal healing, hypertension, and hypokalemia. The diagnosis of 17-OHD was reached by measurement of steroid hormones and abdominal CT scan and confirmed by genetic sequencing, which revealed a homozygous p.R96Q missense mutation in the CYP17A1 gene. The patient received treatment with dexamethasone and estradiol, and 4 months of follow-up showed that both blood pressure and potassium were well controlled. CONCLUSIONS This is the first Asian case of CAH caused by a homozygous p.R96Q missense mutation in the CYP17A1 gene. Herein, we highlight the role of inguinal hernia in the early diagnosis of female 17-OHD and the necessity of removing the ectopic testis.
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Affiliation(s)
- Qian Liao
- Department of Endocrinology, Translational Research Key Laboratory for Diabetes, The Second Affiliated Hospital, Xinqiao Hospital, Army Medical University, Chongqing, China
| | - Rufei Shen
- Department of Endocrinology, Translational Research Key Laboratory for Diabetes, The Second Affiliated Hospital, Xinqiao Hospital, Army Medical University, Chongqing, China
| | - Mingyu Liao
- Department of Endocrinology, Translational Research Key Laboratory for Diabetes, The Second Affiliated Hospital, Xinqiao Hospital, Army Medical University, Chongqing, China
| | - Chenxi Ran
- Department of Endocrinology, Translational Research Key Laboratory for Diabetes, The Second Affiliated Hospital, Xinqiao Hospital, Army Medical University, Chongqing, China
| | - Ling Zhou
- Department of Endocrinology, Translational Research Key Laboratory for Diabetes, The Second Affiliated Hospital, Xinqiao Hospital, Army Medical University, Chongqing, China
| | - Yuling Zhang
- Department of Endocrinology, Translational Research Key Laboratory for Diabetes, The Second Affiliated Hospital, Xinqiao Hospital, Army Medical University, Chongqing, China
| | - Guiliang Peng
- Department of Endocrinology, Translational Research Key Laboratory for Diabetes, The Second Affiliated Hospital, Xinqiao Hospital, Army Medical University, Chongqing, China
| | - Zheng Sun
- Department of Medicine, Division of Diabetes, Endocrinology and Metabolism, Baylor College of Medicine, Houston, TX, United States
- Department of Molecular and Cellular Biology, Baylor College of Medicine, Houston, TX, United States
| | - Hongting Zheng
- Department of Endocrinology, Translational Research Key Laboratory for Diabetes, The Second Affiliated Hospital, Xinqiao Hospital, Army Medical University, Chongqing, China
- *Correspondence: Min Long, ; Hongting Zheng,
| | - Min Long
- Department of Endocrinology, Translational Research Key Laboratory for Diabetes, The Second Affiliated Hospital, Xinqiao Hospital, Army Medical University, Chongqing, China
- *Correspondence: Min Long, ; Hongting Zheng,
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Li J, Zhang Q, Chen J, Fu X, Yang J, Liu L. Case report: 17α- hydroxylase deficiency due to a hotspot variant and a novel compound heterozygous variant in the CYP17 A1 gene of five Chinese patients. Front Pediatr 2022; 10:935191. [PMID: 36210947 PMCID: PMC9532611 DOI: 10.3389/fped.2022.935191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Accepted: 08/31/2022] [Indexed: 11/28/2022] Open
Abstract
17α-Hydroxylase deficiency (17OHD) is a rare form of congenital adrenal hyperplasia caused by mutations in the CYP17A1 gene. It is characterized by impaired adrenal and gonad steroid biosynthesis. Affected patients present with hypertension, hypokalemia, and disorders of sexual development. Here, we describe the genotypes and phenotypes of five patients from three families with this rare disease. Most patients had the hotspot variant, c.985_987delTACinsAA, in CYP17A1, which may be caused by a founder effect. However, the patients in our study were younger than the typical age of onset of 17OHD, and there was a pair of twins with the karyotypes 46, XX and 46, XY, but they both had a female phenotype. Meanwhile, we identified a novel compound heterozygous variant, c.1243+6T>G (p.Y329fs/splicing) in the CYP17A1 gene.
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Affiliation(s)
- Jinying Li
- Department of Endocrinology, Genetics and Metabolism, Children's Hospital of Hebei Province, Shijiazhuang, China
| | - Qiang Zhang
- Department of Endocrinology, Genetics and Metabolism, Children's Hospital of Hebei Province, Shijiazhuang, China
| | - Jing Chen
- Department of Endocrinology, Genetics and Metabolism, Children's Hospital of Hebei Province, Shijiazhuang, China
| | - Xingjiao Fu
- Department of Endocrinology, Genetics and Metabolism, Children's Hospital of Hebei Province, Shijiazhuang, China
| | - Jingpin Yang
- Department of Endocrinology, Genetics and Metabolism, Children's Hospital of Hebei Province, Shijiazhuang, China
| | - Lijun Liu
- Department of Endocrinology, Genetics and Metabolism, Children's Hospital of Hebei Province, Shijiazhuang, China
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Zhou Y, Xue X, Shi P, Lu Q, Lv S. Multidisciplinary team management of 46,XY 17α-hydroxylase deficiency: a case report and literature review. J Int Med Res 2021; 49:300060521993965. [PMID: 33761789 PMCID: PMC8165845 DOI: 10.1177/0300060521993965] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND We report here a case study of 17α-hydroxylase deficiency in a phenotypic girl with male karyotype (46,XY). We also review the relevant literature to deepen our understanding of the disease, reduce the rate of missed diagnosis, and emphasize that holistic management of this disease requires collaborative multidisciplinary teamwork. CASE PRESENTATION A 14-year-old patient with a female phenotype visited the endocrinology department because of hypertension. The patient had primary amenorrhea and lacked secondary sexual characteristics. Initial laboratory evaluation revealed normal levels of electrolytes, a hypergonadotropic hypogonadal state with high progesterone and low testosterone levels, and a 46,XY karyotype. She was referred to the urology department for gonadectomy and transferred to the gynecological endocrine clinic. On the basis of the patient's medical history and genetic testing results, a diagnosis of 46,XY 17α-hydroxylase deficiency was made. The patient was provided with glucocorticoids, estrogens, metformin, and psychological support. CONCLUSIONS Patients with 17α-hydroxylase deficiency, a rare cause of congenital adrenal hyperplasia, should be treated by a multidisciplinary team. Relevant experts from different disciplines should set up a systematic and comprehensive individualized management plan to optimize the physical and mental health and quality of life of affected patients.
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Affiliation(s)
- Yang Zhou
- Department of Gynecology, Affiliated Hospital of Northwestern Polytechnical University, Xi'an, Shaanxi, China
| | - Xue Xue
- Department of Gynecology and Obstetrics, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Panpan Shi
- Department of Gynecology and Obstetrics, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Qinrui Lu
- Department of Gynecology and Obstetrics, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Shulan Lv
- Department of Gynecology and Obstetrics, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
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