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Kunz S, Wang X, Ferrari U, Drey M, Theodoropoulou M, Schilbach K, Reincke M, Heier M, Peters A, Koenig W, Zeller T, Thorand B, Bidlingmaier M. Age- and sex-adjusted reference intervals for steroid hormones measured by liquid chromatography-tandem mass spectrometry using a widely available kit. Endocr Connect 2024; 13:e230225. [PMID: 37938144 PMCID: PMC10762560 DOI: 10.1530/ec-23-0225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 11/08/2023] [Indexed: 11/09/2023]
Abstract
Objective Measurements utilizing commercially available sets of reagents for determination of steroid hormone profiles by liquid chromatography-tandem mass spectrometry (LC-MS/MS) have become increasingly important for routine laboratories. However, method-specific publications of reference intervals obtained from sufficiently large studies are often missing. Methods After validation of performance characteristics, a widely available kit for steroid analysis by LC-MS/MS was used to measure concentrations of 15 endogenous steroids (aldosterone, cortisol, cortisone, corticosterone, 11-deoxycortisol, 21-deoxycortisol, dehydroepiandrosterone sulfate, estradiol, testosterone, androstenedione, dihydrotestosterone, dehydroepiandrosterone, 17-hydroxyprogesterone, 11-deoxycorticosterone, progesterone) in more than 500 blood samples from a population-based study. While randomly selected from a larger cohort, the samples equally represented both sexes and covered a wide range of adult age groups. Age- and sex-specific reference intervals were calculated, and correlation with BMI was assessed. Results Performance characteristics of the assay matched expectations for 9 of 15 steroids. For most of them, reference intervals obtained from our study population were comparable to those reported by others, with age and sex being the major determinants. A sex-specific correlation with BMI was found for seven steroids. We identified limitations regarding sensitivity of the method for quantification of progesterone in males and postmenopausal females. Concentrations of aldosterone, 21-deoxycortisol, estradiol, 11-deoxycorticosterone, and dihydrotestosterone could not be quantified in a large percentage of samples. Conclusions The reference intervals for nine steroids will support meaningful interpretation for steroid profiles as measured by a widely used kit for LC-MS/MS-based quantification. Laboratories using such kits must be aware of potential limitations in sensitivity for some steroids included in the profile. Significance Statement Quantification of steroid hormones is a cornerstone for diagnosis of several diseases. Commonly used immunoassays have limitations in specificity. Liquid chromatography-tandem mass spectrometry (LC-MS/MS) is a promising alternative, particularly if methods are harmonized across laboratories. The use of kits from commercial suppliers might support this. Clinical interpretation of steroid concentrations requires availability of appropriate reference intervals (RIs), but studies on RIs reported in the literature differ in preanalytical and analytical procedures. Here, we provide RIs for steroids measured by a widely available kit under preanalytical conditions mirroring common clinical practice. Such RIs might facilitate interpretation for those using the same method and comparable conditions in clinical routine.
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Affiliation(s)
- Sonja Kunz
- Department of Medicine IV, University Hospital, Ludwig Maximilian University Munich, Munich, Germany
| | - Xiao Wang
- Department of Medicine IV, University Hospital, Ludwig Maximilian University Munich, Munich, Germany
| | - Uta Ferrari
- Department of Medicine IV, University Hospital, Ludwig Maximilian University Munich, Munich, Germany
| | - Michael Drey
- Department of Medicine IV, University Hospital, Ludwig Maximilian University Munich, Munich, Germany
| | - Marily Theodoropoulou
- Department of Medicine IV, University Hospital, Ludwig Maximilian University Munich, Munich, Germany
| | - Katharina Schilbach
- Department of Medicine IV, University Hospital, Ludwig Maximilian University Munich, Munich, Germany
| | - Martin Reincke
- Department of Medicine IV, University Hospital, Ludwig Maximilian University Munich, Munich, Germany
| | - Margit Heier
- Institute of Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany
- KORA Study Centre, University Hospital of Augsburg, Augsburg, Augsburg, Germany
| | - Annette Peters
- Institute of Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany
- German Centre for Cardiovascular Research (DZHK), Partner site Munich Heart Alliance, Munich, Germany
| | - Wolfgang Koenig
- German Centre for Cardiovascular Research (DZHK), Partner site Munich Heart Alliance, Munich, Germany
- German Heart Centre Munich, Technical University of Munich, Munich, Germany
- Institute of Epidemiology and Medical Biometry, University of Ulm, Ulm, Germany
| | - Tanja Zeller
- Department of General and Interventional Cardiology, University Heart Center Hamburg, Hamburg, Germany
- German Centre for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany
| | - Barbara Thorand
- Institute of Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany
| | - Martin Bidlingmaier
- Department of Medicine IV, University Hospital, Ludwig Maximilian University Munich, Munich, Germany
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Design and Validation of a Sensitive Multisteroid LC-MS/MS Assay for the Routine Clinical Use: One-Step Sample Preparation with Phospholipid Removal and Comparison to Immunoassays. Int J Mol Sci 2022; 23:ijms232314691. [PMID: 36499017 PMCID: PMC9736865 DOI: 10.3390/ijms232314691] [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: 11/07/2022] [Accepted: 11/19/2022] [Indexed: 11/26/2022] Open
Abstract
Steroid analysis in clinical laboratories is dominated by immunoassays (IAs) that have a high sample turnover but are inherently limited in trueness, precision, and sensitivity. Liquid chromatography coupled to mass spectrometry (LC-MS/MS) has proved to be a far more capable tool, delivering better sensitivity, specificity, and the possibility of parallel analysis of multiple steroids and metabolites, providing the endocrinologist with more reliable and comprehensive diagnostic information. An LC-MS/MS assay with gradient elution over less than eight minutes and a one-step sample preparation combining protein precipitation with phospholipid removal of off-line solid-phase extraction was developed and validated. It allowed the quantification of 11-deoxycorticosterone (11-DOC), 11-deoxycortisol (11-DF), 17-OH-progesterone (17P), 21-deoxycortisol (21-DF), androstenedione (ANDRO), aldosterone (ALDO), corticosterone (CC), cortisol (CL), cortisone (CN), dehydroepiandrosterone (DHEA), dehydroepiandrosterone sulfate (DHEAS), dihydrotestosterone (DHT), estradiol (E2), progesterone (PROG), and testosterone (TES) in human serum. Interday imprecision was generally better than 15%, trueness was proven by recovery experiments with ISO 17034-certified reference materials, proficiency testing (UK NEQAS), and measuring serum reference standards. In-house comparison against IVD-CE-certified immunoassays (IA) for 17P, ANDRO, CL, DHEAS, E2, PROG, and TES was conducted by assessing leftover routine patient samples and purpose-built patient serum pools. None of the compared routine IAs were meeting the standards of the LC-MS/MS. Insufficient overall comparability was found for ANDRO and 17P (mean bias > +65%). Accuracy limitations at lower concentrations were present in IAs for PROG, E2, and TES.
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Reddy NA, Sharma S, Das M, Kapoor A, Maskey U. Devastating salt‐wasting crisis in a four‐month‐old male child with congenital adrenal hyperplasia, highlighting the essence of neonatal screening. Clin Case Rep 2022; 10:e6010. [PMID: 35846927 PMCID: PMC9272202 DOI: 10.1002/ccr3.6010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Revised: 05/24/2022] [Accepted: 06/07/2022] [Indexed: 11/29/2022] Open
Abstract
Congenital adrenal hyperplasia (CAH) is a rare condition usually referred to as a group of genetic disorders resulting due to a deficiency of steroid enzymes required by adrenal glands to produce cortisol and mineralocorticoid hormones. It has an autosomal recessive mode of inheritance and is further categorized into two types—Classic and Non‐Classic. Non‐Classic CAH is a more common milder form that presents late after puberty. Classic CAH, although more severe, is rare and detected at birth and is associated with the life‐threatening adrenal crisis in both sexes and virilization of the external genitalia in females (46, XX) patients, whereas in males, no overt abnormality of the external genitalia is present. We present a case of a four‐month‐old male child with the classic form of CAH who was brought with complaints of loose stools, projectile non bilious vomiting, decreased urine output, and failure to feed for 3 days. The child had a clinical presentation of salt wasting with hypoglycemia and hyperpigmentation of his genitalia. The USG findings revealed increased anteroposterior diameter of renal pelvis indicative of a growth in the suprarenal area. 17‐hydroxyprogesterone (17‐OHP) was found to be elevated confirming the diagnosis. He was treated with hydrocortisone with gradual improvement in his glucose and electrolytes. The patient was discharged home on replacement therapy consisting of oral prednisolone and fludrocortisone acetate and followed up as outpatient with significant improvement in the clinical findings. The fact that the child was not screened for CAH at birth led to the critical consequences of the disease in this case. To prevent life‐threatening adrenal crisis and help perform appropriate sex assignments for affected female patients, newborn screening (NBS) programs for the classical form of CAH should be made mandatory even in low‐ and middle‐income countries.
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Affiliation(s)
| | | | - Mainak Das
- Nilratan Sircar Medical College Kolkata India
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Sadighbayan D, Minhas-Khan A, Ghafar-Zadeh E. Laser-Induced Graphene-Functionalized Field-Effect Transistor-Based Biosensing: A Potent Candidate for COVID-19 Detection. IEEE Trans Nanobioscience 2021; 21:232-245. [PMID: 34648455 PMCID: PMC9088816 DOI: 10.1109/tnb.2021.3119996] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Speedy and on-time detection of coronavirus disease 2019 (COVID-19) is of high importance to control the pandemic effectively and stop its disastrous consequences. A widely available, reliable, label-free, and rapid test that can recognize tiny amounts of specific biomarkers might be the solution. Nanobiosensors are one of the most attractive candidates for this purpose. Integration of graphene with biosensing devices shifts the performance of these systems to an incomparable level. Between the various arrangements using this wonder material, field-effect transistors (FETs) display a precise detection even in complex samples. The emergence of pioneering biosensors for detecting a wide range of diseases especially COVID-19 created the incentive to prepare a review of the recent graphene-FET biosensing platforms. However, the graphene fabrication and transfer to the surface of the device is an imperative factor for researchers to take into account. Therefore, we also reviewed the common methods of manufacturing graphene for biosensing applications and discuss their advantages and disadvantages. One of the most recent synthesizing techniques - laser-induced graphene (LIG) - is attracting attention owing to its extraordinary benefits which are thoroughly explained in this article. Finally, a conclusion highlighting the current challenges is presented.
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Klenotic PA, Moseng MA, Morgan CE, Yu EW. Structural and Functional Diversity of Resistance-Nodulation-Cell Division Transporters. Chem Rev 2021; 121:5378-5416. [PMID: 33211490 PMCID: PMC8119314 DOI: 10.1021/acs.chemrev.0c00621] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Multidrug resistant (MDR) bacteria are a global threat with many common infections becoming increasingly difficult to eliminate. While significant effort has gone into the development of potent biocides, the effectiveness of many first-line antibiotics has been diminished due to adaptive resistance mechanisms. Bacterial membrane proteins belonging to the resistance-nodulation-cell division (RND) superfamily play significant roles in mediating bacterial resistance to antimicrobials. They participate in multidrug efflux and cell wall biogenesis to transform bacterial pathogens into "superbugs" that are resistant even to last resort antibiotics. In this review, we summarize the RND superfamily of efflux transporters with a primary focus on the assembly and function of the inner membrane pumps. These pumps are critical for extrusion of antibiotics from the cell as well as the transport of lipid moieties to the outer membrane to establish membrane rigidity and stability. We analyze recently solved structures of bacterial inner membrane efflux pumps as to how they bind and transport their substrates. Our cumulative data indicate that these RND membrane proteins are able to utilize different oligomerization states to achieve particular activities, including forming MDR pumps and cell wall remodeling machineries, to ensure bacterial survival. This mechanistic insight, combined with simulated docking techniques, allows for the design and optimization of new efflux pump inhibitors to more effectively treat infections that today are difficult or impossible to cure.
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Affiliation(s)
- Philip A. Klenotic
- Department of Pharmacology, Case Western Reserve University School of Medicine, Cleveland OH 44106, USA
| | - Mitchell A. Moseng
- Department of Pharmacology, Case Western Reserve University School of Medicine, Cleveland OH 44106, USA
| | - Christopher E. Morgan
- Department of Pharmacology, Case Western Reserve University School of Medicine, Cleveland OH 44106, USA
| | - Edward W. Yu
- Department of Pharmacology, Case Western Reserve University School of Medicine, Cleveland OH 44106, USA
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Lee MA, Wang S, Jin X, Bakh NA, Nguyen FT, Dong J, Silmore KS, Gong X, Pham C, Jones KK, Muthupalani S, Bisker G, Son M, Strano MS. Implantable Nanosensors for Human Steroid Hormone Sensing In Vivo Using a Self-Templating Corona Phase Molecular Recognition. Adv Healthc Mater 2020; 9:e2000429. [PMID: 32940022 DOI: 10.1002/adhm.202000429] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Revised: 08/13/2020] [Indexed: 12/19/2022]
Abstract
Dynamic measurements of steroid hormones in vivo are critical, but steroid sensing is currently limited by the availability of specific molecular recognition elements due to the chemical similarity of these hormones. In this work, a new, self-templating synthetic approach is applied using corona phase molecular recognition (CoPhMoRe) targeting the steroid family of molecules to produce near infrared fluorescent, implantable sensors. A key limitation of CoPhMoRe has been its reliance on library generation for sensor screening. This problem is addressed with a self-templating strategy of polymer design, using the examples of progesterone and cortisol sensing based on a styrene and acrylic acid copolymer library augmented with an acrylated steroid. The pendant steroid attached to the corona backbone is shown to self-template the phase, providing a unique CoPhMoRE design strategy with high efficacy. The resulting sensors exhibit excellent stability and reversibility upon repeated analyte cycling. It is shown that molecular recognition using such constructs is viable even in vivo after sensor implantation into a murine model by employing a poly (ethylene glycol) diacrylate (PEGDA) hydrogel and porous cellulose interface to limit nonspecific absorption. The results demonstrate that CoPhMoRe templating is sufficiently robust to enable a new class of continuous, in vivo biosensors.
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Affiliation(s)
- Michael A. Lee
- Department of Chemical Engineering Massachusetts Institute of Technology Cambridge MA 02139 USA
| | - Song Wang
- Department of Chemical Engineering Massachusetts Institute of Technology Cambridge MA 02139 USA
| | - Xiaojia Jin
- Department of Chemical Engineering Massachusetts Institute of Technology Cambridge MA 02139 USA
| | - Naveed Ali Bakh
- Department of Chemical Engineering Massachusetts Institute of Technology Cambridge MA 02139 USA
| | - Freddy T. Nguyen
- Department of Chemical Engineering Massachusetts Institute of Technology Cambridge MA 02139 USA
| | - Juyao Dong
- Department of Chemical Engineering Massachusetts Institute of Technology Cambridge MA 02139 USA
| | - Kevin S. Silmore
- Department of Chemical Engineering Massachusetts Institute of Technology Cambridge MA 02139 USA
| | - Xun Gong
- Department of Chemical Engineering Massachusetts Institute of Technology Cambridge MA 02139 USA
| | - Crystal Pham
- Department of Chemical Engineering Massachusetts Institute of Technology Cambridge MA 02139 USA
| | - Kelvin K. Jones
- Department of Chemical Engineering Massachusetts Institute of Technology Cambridge MA 02139 USA
| | - Sureshkumar Muthupalani
- Division of Comparative Medicine Massachusetts Institute of Technology Cambridge MA 02139 USA
| | - Gili Bisker
- Department of Chemical Engineering Massachusetts Institute of Technology Cambridge MA 02139 USA
- Department of Biomedical Engineering Tel‐Aviv University Tel Aviv 6997801 Israel
| | - Manki Son
- Department of Chemical Engineering Massachusetts Institute of Technology Cambridge MA 02139 USA
| | - Michael S. Strano
- Department of Chemical Engineering Massachusetts Institute of Technology Cambridge MA 02139 USA
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Raju S, Golla A, Prasad K. A rare case of hypertension in a young (fe)male. Indian J Nephrol 2020; 30:133-135. [PMID: 32269442 PMCID: PMC7132850 DOI: 10.4103/ijn.ijn_446_17] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Revised: 11/14/2018] [Accepted: 03/09/2019] [Indexed: 11/04/2022] Open
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Vasudevan RC, Madayi RV, Nambiar RR. Moyamoya syndrome in a male pseudohermaphrodite patient with congenital adrenal hyperplasia - a rare association. Case report and review of literature. Br J Neurosurg 2019:1-3. [PMID: 31588818 DOI: 10.1080/02688697.2019.1672859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Background and importance: Moyamoya syndrome causes progressive stenosis of intracranial internal carotid arteries and may be associated with genetic disorders like Down's or Turner's syndromes. We treated a male pseudohermaphrodite patient with congenital adrenal hyperplasia (CAH) with clinical and radiological features of moyamoya vasculopathy. To our knowledge, this association has not been reported. Clinical presentation: The 42-year-old patient presented with an intraventicular bleed. Cerebral angiography revealed moyamoya vasculopathy. He was hypertensive and had primary amenorrhea. Secondary sexual characteristics were poorly developed and he had ambiguous genitalia. Breast development was Tanner stage 3. Investigation revealed hypokalemia. With primary amenorrhea, persistent hypokalemia, hypertension and ambiguous genitalia, CAH was considered as a possibility and confirmed on hormone profile. Karyotyping revealed 46XY pattern. Abdominal ultrasound revealed hyperplasia of the adrenal glands, absent uterus and ovaries and ectopic testicles in inguinal canals. He was put on steroids and his blood pressure controlled. Conclusions: To the best of our knowledge we report the first case of moyamoya syndrome occurring in association with CAH.
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Affiliation(s)
| | - Reshma Vachali Madayi
- Department of Obstetrics and Gynecology, Indira Gandhi hospital , Tellicherry , India
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9
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Zalas D, Reinehr T, Niedziela M, Borzikowsky C, Flader M, Simic-Schleicher G, Akkurt HI, Heger S, Hornig N, Holterhus PM, Kulle AE. Multiples of Median-Transformed, Normalized Reference Ranges of Steroid Profiling Data Independent of Age, Sex, and Units. Horm Res Paediatr 2018; 89:255-264. [PMID: 29694956 DOI: 10.1159/000488028] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2017] [Accepted: 02/27/2018] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND/AIMS The high complexity of pediatric reference ranges across age, sex, and units impairs clinical application and comparability of steroid hormone data, e.g., in congenital adrenal hyperplasia (CAH). We developed a multiples-of-median (MoM) normalization tool to overcome this major drawback in pediatric endocrinology. METHODS Liquid chromatography tandem mass spectrometry data comprising 10 steroid hormones representing 905 controls (555 males, 350 females, 0 to > 16 years) from 2 previous datasets were MoM transformed across age and sex. Twenty-three genetically proven CAH patients were included (21-hydroxylase deficiency [21OHD], n = 19; 11β-hydroxylase deficiency [11OHD], n = 4). MoM cutoffs for single steroids predicting 21OHD and 11OHD were computed and validated through new, independent patients (21OHD, n = 8; adrenal cortical carcinoma, n = 6; obesity, n = 40). RESULTS 21OHD and 11OHD patients showed disease-typical, easily recognizable MoM patterns independent of age, sex, and concentration units. Two single-steroid cutoffs indicated 21OHD: 3.87 MoM for 17-hydroxyprogesterone (100% sensitivity and 98.83% specificity) and 12.28 MoM for 21-deoxycortisol (94.74% sensitivity and 100% specificity). A cutoff of 13.18 MoM for 11-deoxycortisol indicated 11OHD (100% sensitivity and 100% specificity). CONCLUSIONS Age- and sex-independent MoMs are straightforward for a clinically relevant display of multi-steroid patterns. In addition, defined single-steroid MoMs can serve alone as predictors of 21OHD and 11OHD. Finally, MoM transformation offers substantial enhancement of routine and scientific steroid hormone data exchange due to improved comparability.
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Affiliation(s)
- Dominika Zalas
- Division of Pediatric Endocrinology and Diabetes, Department of Pediatrics, University Medical Center SH, Campus Kiel, Kiel, Germany.,Department of Pediatric Endocrinology and Rheumatology, Poznan University of Medical Sciences, Poznan, Poland
| | - Thomas Reinehr
- Vestische Hospital for Children and Adolescents, University of Witten/Herdecke, Datteln, Germany
| | - Marek Niedziela
- Department of Pediatric Endocrinology and Rheumatology, Poznan University of Medical Sciences, Poznan, Poland
| | - Christoph Borzikowsky
- Institute of Medical Informatics and Statistics, University Medical Center SH, Campus Kiel, Kiel, Germany
| | - Maciej Flader
- Department of Pediatric Endocrinology and Rheumatology, Poznan University of Medical Sciences, Poznan, Poland
| | | | | | - Sabine Heger
- Children's Hospital "Auf der Bult", Hannover, Germany
| | - Nadine Hornig
- Division of Pediatric Endocrinology and Diabetes, Department of Pediatrics, University Medical Center SH, Campus Kiel, Kiel, Germany
| | - Paul-Martin Holterhus
- Division of Pediatric Endocrinology and Diabetes, Department of Pediatrics, University Medical Center SH, Campus Kiel, Kiel, Germany
| | - Alexandra E Kulle
- Division of Pediatric Endocrinology and Diabetes, Department of Pediatrics, University Medical Center SH, Campus Kiel, Kiel, Germany
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Xu S, Hu S, Yu X, Zhang M, Yang Y. 17α‑hydroxylase/17,20‑lyase deficiency in congenital adrenal hyperplasia: A case report. Mol Med Rep 2016; 15:339-344. [PMID: 27959413 PMCID: PMC5355729 DOI: 10.3892/mmr.2016.6029] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2015] [Accepted: 11/11/2016] [Indexed: 12/13/2022] Open
Abstract
Congenital adrenal hyperplasia (CAH) is a rare autosomal recessive disorder caused by mutations in the cytochrome P450 family 17 subfamily A member 1 (CYP17A1) gene located on chromosome 10q24.3, which leads to a deficiency in 17α-hydroxylase/17,20-lyase. The disorder is characterized by low blood levels of estrogens, androgens and cortisol, which leads to a compensatory increase in adrenocorticotropic hormone levels that stimulate the production of mineralocorticoid precursors. This subsequently leads to hypertension, hypokalemia, primary amenorrhea and sexual infantilism. Over 90 distinct genetic lesions have been identified in patients with this disorder. The prevalence of common mutation of CYP17A1 gene differs among ethnic groups. Treatment of this disorder involves replacement of glucocorticoids and sex steroids. Estrogen alone is prescribed for patients who are biologically male with 17α-hydroxylase deficiencies that identify as female. However, genetically female patients may receive estrogen and progesterone supplementation. In the present study, a 17-year-old female with 17α-hydroxylase/17,20-lyase deficiency that presented with primary amenorrhea and sexual infantilism and no hypertension, was examined. The karyotype of the patient was 46, XX, and genetic analysis revealed the presence of a compound heterozygous mutation in exons 6 and 8, leading to the complete absence of 17α-hydroxylase/17,20-lyase activity. The patient was treated with prednisolone and ethinyl estradiol. In addition, a summary of the recent literature regarding CAH is presented.
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Affiliation(s)
- Simiao Xu
- Department of Endocrinology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, P.R. China
| | - Shuhong Hu
- Department of Endocrinology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, P.R. China
| | - Xuefeng Yu
- Department of Endocrinology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, P.R. China
| | - Muxun Zhang
- Department of Endocrinology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, P.R. China
| | - Yan Yang
- Department of Endocrinology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, P.R. China
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Soveid M, Rais-Jalali GA. Seventeen Alpha-Hydroxylase Deficiency Associated with Absent Gonads and Myelolipoma: A Case Report and Review of Literature. IRANIAN JOURNAL OF MEDICAL SCIENCES 2016; 41:543-547. [PMID: 27853336 PMCID: PMC5106571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Congenital adrenal hyperplasia comprises a group of disorders resulting from defects in enzymes required for the synthesis of cortisol. The clinical presentation depends on the specific enzyme defect. We report a rare case of congenital adrenal hyperplasia due to 17 alpha-hydroxylase deficiency. A 26-year-old female patient referred with hypertension and hypokalemia. She also had primary amenorrhea and lack of sexual development. The karyotype was 46, XY. Hormonal evaluation showed low serum levels of all steroid hormones, requiring alpha-hydroxylation, which included cortisol, 17 alpha-hydroxy progesterone, dehydroepiandrosterone sulfate, estradiol, and testosterone. The levels of adrenocorticotropic, follicle-stimulating, and luteinizing hormones were high. Radiological and surgical investigations failed to show a gonad. She also had a large myelolipoma. Treatment was commenced with low-dose dexamethasone and conjugated estrogen. Her hypertension and hypokalemia were resolved. The myelolipoma was removed by laparoscopy due to pain and sensation of heaviness. Our review of literature revealed that a combination of this disorder with either agonadism or myelolipoma is very rare and that only 2 previous cases have been reported for each entity.
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Affiliation(s)
- Mahmood Soveid
- Endocrinology and Metabolism Research Center, Department of Internal Medicine, Nemazee Teaching Hospital, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran,Correspondence: Mahmood Soveid, MD; Endocrinology and Metabolism Research Center, Nemazee Hospital, Nemazee Sq. Shiraz, Iran Tel: +98 71 36489686 Fax: +98 71 36474316
| | - Ghanbar Ali Rais-Jalali
- Department of Internal Medicine, Nemazee Teaching Hospital, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
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Quanson JL, Stander MA, Pretorius E, Jenkinson C, Taylor AE, Storbeck KH. High-throughput analysis of 19 endogenous androgenic steroids by ultra-performance convergence chromatography tandem mass spectrometry. J Chromatogr B Analyt Technol Biomed Life Sci 2016; 1031:131-138. [DOI: 10.1016/j.jchromb.2016.07.024] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2016] [Revised: 07/06/2016] [Accepted: 07/13/2016] [Indexed: 01/13/2023]
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Lokhov PG, Maslov DL, Balashova EE, Trifonova OP, Medvedeva NV, Torkhovskaya TI, Ipatova OM, Archakov AI, Malyshev PP, Kukharchuk VV, Shestakova EA, Shestakova MV, Dedov II. Mass spectrometry analysis of blood plasma lipidome as the method of disease diagnostics, evalution of effectiveness and optimization of drug therapy. BIOCHEMISTRY (MOSCOW) SUPPLEMENT SERIES B: BIOMEDICAL CHEMISTRY 2015. [DOI: 10.1134/s1990750815020109] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Abstract
Adrenal insufficiency is a life-threatening condition that occurs secondary to impaired secretion of adrenal glucocorticoid and mineralocorticoid hormones. This condition can be caused by primary destruction or dysfunction of the adrenal glands or impairment of the hypothalamic-pituitary-adrenal axis. In children, the most common causes of primary adrenal insufficiency are impaired adrenal steroidogenesis (congenital adrenal hyperplasia) and adrenal destruction or dysfunction (autoimmune polyendocrine syndrome and adrenoleukodystrophy), whereas exogenous corticosteroid therapy withdrawal or poor adherence to scheduled corticosteroid dosing with long-standing treatment constitute the most common cause of acquired adrenal insufficiency. Although there are classic clinical signs (eg, fatigue, orthostatic hypotension, hyperpigmentation, hyponatremia, hyperkalemia, and hypoglycemia) of adrenal insufficiency, its early clinical presentation is most commonly vague and undefined, requiring a high index of suspicion. The relevance of early identification of adrenal insufficiency is to avoid the potential lethal outcome secondary to severe cardiovascular and hemodynamic insufficiency. The clinician must be aware of the need for increased corticosteroid dose supplementation during stress periods.
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Affiliation(s)
- Moises Auron
- Department of Hospital Medicine, Medicine Institute, Cleveland Clinic, Cleveland, OH. Department of Pediatric Hospital Medicine, Cleveland Clinic Children's, Cleveland, OH
| | - Nouhad Raissouni
- Department of Pediatric Endocrinology, Cleveland Clinic Children's, Cleveland, OH
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15
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Lokhov P, Maslov D, Balashova E, Trifonova O, Medvedeva N, Torkhovskaya T, Ipatova O, Archakov A, Malyshev P, Kukharchuk V, Shestakova E, Shestakova M, Dedov I. Mass spectrometry analysis of blood plasma lipidome as method of disease diagnostics, evuation of effectiveness and optimization of drug therapy. ACTA ACUST UNITED AC 2015; 61:7-18. [DOI: 10.18097/pbmc20156101007] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
A new method for the analysis of blood lipid based on direct mass spectrometry of lipophilic low molecular weight fraction of blood plasma has been considered. Such technique allows quantification of hundreds of various types of lipids and this changes existing concepts on diagnostics of lipid disorders and related diseases. The versatility and quickness of the method significantly simplify its wide use. This method is applicable for diagnostics of atherosclerosis, diabetes, cancer and other diseases. Detalization of plasma lipid composition at the molecular level by means of mass spectrometry allows to assess the effectiveness of therapy and to optimize the drug treatment of cardiovascular diseases by phospholipid preparations.
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Affiliation(s)
- P.G. Lokhov
- Institute of Biomedical Chemistry, Moscow, Russia
| | - D.L. Maslov
- Institute of Biomedical Chemistry, Moscow, Russia
| | | | | | | | | | - O.M. Ipatova
- Institute of Biomedical Chemistry, Moscow, Russia
| | | | - P.P. Malyshev
- Russian Cardiology Research and Production Complex, Moscow, Russia
| | - V.V. Kukharchuk
- Russian Cardiology Research and Production Complex, Moscow, Russia
| | | | | | - I.I. Dedov
- Endocrinology Research Centre, Moscow, Russia
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16
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Aydın BK, Demirkol D, Baş F, Türkoğlu U, Kumral A, Karaböcüoğlu M, Cıtak A, Darendeliler F. Evaluation of endocrine function in children admitted to pediatric intensive care unit. Pediatr Int 2014; 56:349-53. [PMID: 24299000 DOI: 10.1111/ped.12269] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2013] [Revised: 10/24/2013] [Accepted: 11/13/2013] [Indexed: 01/22/2023]
Abstract
BACKGROUND Although studied widely in adulthood, little is known about endocrinological disorders during critical illnesses in childhood. The aims of this study were to define the endocrinological changes in patients admitted to pediatric intensive care unit (PICU) and to identify their effects on prognosis. METHODS Forty patients with a mean age of 5.1 years admitted to PICU were enrolled in the study. Blood samples were taken at admission and at 24 and 48 h to measure cortisol, adrenocorticotropic hormone (ACTH), prolactin, growth hormone (GH), GH binding protein (GHBP), insulin-like growth factor-binding protein-3 (IGFBP-3) and interleukin-6 (IL-6). The severity of the patient's condition was assessed using pediatric risk of mortality (PRISM) and pediatric logistic organ dysfunction (PELOD) scores. RESULTS PRISM and PELOD scores were significantly higher in non-survivors. Cortisol, ACTH, prolactin, GH, GHBP, IGFBP-3 and IL-6 were not significantly different between the survivors and non-survivors. There was a negative correlation between baseline IGFBP-3 and PRISM scores. A positive correlation was seen between cortisol level at 24 h and PRISM score. On multivariate linear regression analysis, PRISM score was best explained by ACTH and cortisol at 24 h. A positive weak correlation was detected between IL-6 at 24 h and PELOD scores. CONCLUSIONS Although there was no difference between survivors and non-survivors regarding the studied endocrine parameters, there were associations between cortisol, ACTH, IL-6 and IGFBP-3 and risk assessment scores, and, given that these scores correlated with mortality, these parameters might be useful as prognostic factors.
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Affiliation(s)
- Banu Küçükemre Aydın
- Department of Pediatrics, Pediatric Endocrinology Unit, Istanbul University, Istanbul, Turkey
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17
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Mula-Abed WAS, Pambinezhuth FB, Al-Kindi MK, Al-Busaidi NB, Al-Muslahi HN, Al-Lamki MA. Congenital Adrenal Hyperplasia due to 17-alpha-hydoxylase/17,20-lyase Deficiency Presenting with Hypertension and Pseudohermaphroditism: First Case Report from Oman. Oman Med J 2014; 29:55-9. [PMID: 24498484 DOI: 10.5001/omj.2014.12] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2013] [Accepted: 12/02/2013] [Indexed: 11/03/2022] Open
Abstract
This is the first report of congenital adrenal hyperplasia (CAH) due to combined 17α-hydroxylase/17,20 lyase deficiency in an Omani patient who was initially treated for many years as a case of hypertension. CAH is an uncommon disorder that results from a defect in steroid hormones biosynthesis in the adrenal cortex. The clinical presentation depends on the site of enzymatic mutations and the types of accumulated steroid precursors. A 22-year-old woman who was diagnosed to have hypertension since the age of 10 years who was treated with anti-hypertensive therapy was referred to the National Diabetes and Endocrine Centre, Royal Hospital, Oman. The patient also had primary amenorrhea and features of sexual infantilism. Full laboratory and radio-imaging investigations were done. Adrenal steroids, pituitary function and karyotyping study were performed and the diagnosis was confirmed by molecular mutation study. Laboratory investigations revealed adrenal steroids and pituitary hormones profile in addition to 46XY karyotype that are consistent with the diagnosis of CAH due to 17α-hydroxylase deficiency. Extensive laboratory workup revealed low levels of serum cortisol (and its precursors 17α-hydroxyprogesterone and 11-deoxycortisol), adrenal androgens (dehydroepiandrosterone sulfate and androstenedione), and estrogen (estradiol); and high levels of mineralocorticoids precursors (11-deoxycorticosterone and corticosterone) with high levels of ACTH, FSH and LH. Mutation analysis revealed CYP17A1-homozygous mutation (c.287G>A p.Arg96Gln) resulting in the complete absence of 17α-hydroxylase/17,20-lyase activity. The patient was treated with dexamethasone and ethinyl estradiol with cessation of anti-hypertensive therapy. A review of the literature was conducted to identify previous studies related to this subtype of CAH. This is the first biochemically and genetically proven case of CAH due to 17α-hydroxylase/17,20-lyase deficiency in Oman and in the Arab World described in the literature.
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Affiliation(s)
- Waad-Allah S Mula-Abed
- Department of Chemical Pathology, Royal Hospital, P.O. Box 1331, Seeb 111, Muscat, Sultanate of Oman
| | | | - Manal K Al-Kindi
- Department of Chemical Pathology, Royal Hospital, P.O. Box 1331, Seeb 111, Muscat, Sultanate of Oman
| | - Noor B Al-Busaidi
- Centre, Royal Hospital, P.O. Box 1331, Seeb 111, Muscat, Sultanate of Oman
| | - Hilal N Al-Muslahi
- Centre, Royal Hospital, P.O. Box 1331, Seeb 111, Muscat, Sultanate of Oman
| | - Mohammad A Al-Lamki
- Medical Endo-Metabolic Unit, Royal Hospital, P.O. Box 1331, Seeb 111, Muscat, Sultanate of Oman
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