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Elabd S, Almohareb O, AlJaroudi D, Al Zahrani A, Brema I. A Case Report of 17α-Hydroxylase Deficiency in Two Saudi Siblings With Different Karyotyping. Cureus 2024; 16:e52191. [PMID: 38222995 PMCID: PMC10787212 DOI: 10.7759/cureus.52191] [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] [Accepted: 01/12/2024] [Indexed: 01/16/2024] Open
Abstract
Congenital adrenal hyperplasia (CAH) consists of variable disorders of sex determination and differentiation. 17α-hydroxylase deficiency (17OHD) is an uncommon form of those disorders, which is typically characterized by hypertension, hypokalemia, failure of puberty, and ambiguous genitalia. The 17α-hydroxylase enzyme is encoded by the CYP17A1 gene and it is required for the synthesis of cortisol and sex steroids. The affected females with 17OHD usually present with primary amenorrhea and delayed puberty, which are associated with hypertension and hypokalemia while male patients might show female external genitalia, pseudohermaphroditism, or variable degrees of ambiguous genitalia with intra-abdominal testes in addition to hypertension and hypokalemia as well. We present two Saudi siblings (19 and 16 years old) who were diagnosed with the rare CAH subtype of 17OHD after presenting with long-standing hypertension, refractory hypokalemia, and failure of puberty. It is interesting that both siblings had biochemical primary adrenal insufficiency; however, both patients did not clinically present with an acute adrenal crisis, which is likely due to the effect of increased levels of deoxycorticosterone. Additionally, although both patients have similar phenotypes and clinical presentations, they have different karyotypes. This again highlights the variability of the manifestations that can result from 17OHD even with an identical mutation in the same family. Both patients were treated successfully with dexamethasone, which has led to the normalization of hypertension, resolution of hypokalemia, and discontinuation of anti-hypertensive medications and potassium supplements after several years of treatment. However, the entire management is quite challenging and requires a multidisciplinary approach regarding difficult issues such as gender identity and assignment and fertility issues in addition to a life-long follow-up.
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Affiliation(s)
- Souha Elabd
- Obesity, Endocrine, and Metabolism Center, King Fahad Medical City, Riyadh, SAU
| | - Ohoud Almohareb
- Obesity, Endocrine, and Metabolism Center, King Fahad Medical City, Riyadh, SAU
| | - Dania AlJaroudi
- Department of Reproductive Endocrine and Infertility Medicine, King Fahad Medical City, Riyadh, SAU
| | - Ali Al Zahrani
- Department of Medicine, King Faisal Specialist Hospital and Research Centre, Riyadh, SAU
| | - Imad Brema
- Obesity, Endocrine, and Metabolism Center, King Fahad Medical City, Riyadh, SAU
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Ishinoda Y, Uto A, Yamada Y, Okazaki M, Asada H, Wakamatsu S, Kurihara I, Shibata H, Ishii T, Hasegawa T, Kumagai H, Kasuga A. An elderly patient with 17α-hydroxylase deficiency misdiagnosed as primary aldosteronism: a case report. BMC Endocr Disord 2022; 22:300. [PMID: 36461073 PMCID: PMC9717510 DOI: 10.1186/s12902-022-01216-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Accepted: 11/14/2022] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND 17α-hydroxylase deficiency (17OHD) is a rare autosomal recessive disorder. Aldosterone levels are usually low in patients with 17OHD. However, among the approximately 150 cases of 17OHD reported to date, aldosterone levels were not low in all cases. Therefore, some 17OHD cases may have been misdiagnosed as primary aldosteronism (PA) cases. Often before puberty, 17OHD is diagnosed because of abnormal genital morphology and menstrual irregularities. However, we report a very rare case of 17OHD in an elderly patient with a high aldosterone/renin ratio (ARR) similar to that in PA. CASE PRESENTATION A 63-year-old Japanese woman was transferred to our medical facility for the evaluation of bilateral adrenal hypertrophy, which was incidentally discovered during an abdominal examination after cholecystectomy. The patient had hypokalemia and a high aldosterone/renin ratio. Her medical history included hypertension and right intracerebral capsular hemorrhage at the age of 30 years. Additional testing revealed low cortisol, high adrenocorticotropic hormone, and low testosterone and dehydroepiandrosterone sulfate, indicating congenital adrenal hyperplasia. Genetic analysis revealed a mutation in the CYP17A1 gene and a karyotype of 46, XY; hence, she was diagnosed with 17OHD. CONCLUSION 17OHD can resemble PA. The combination of a high ARR and low cortisol level should trigger the consideration of 17OHD.
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Affiliation(s)
- Yuki Ishinoda
- Department of Endocrinology, National Defense Medical College, 3-2 Namiki, 359-8513, Tokorozawa-shi, Saitama, Japan.
| | - Asuka Uto
- Department of Endocrinology, National Defense Medical College, 3-2 Namiki, 359-8513, Tokorozawa-shi, Saitama, Japan
| | - Yoshifumi Yamada
- Department of Endocrinology, National Defense Medical College, 3-2 Namiki, 359-8513, Tokorozawa-shi, Saitama, Japan
| | - Maki Okazaki
- Department of Endocrinology, National Defense Medical College, 3-2 Namiki, 359-8513, Tokorozawa-shi, Saitama, Japan
| | - Hidetomo Asada
- Department of Endocrinology, National Defense Medical College, 3-2 Namiki, 359-8513, Tokorozawa-shi, Saitama, Japan
| | - Seina Wakamatsu
- Department of Endocrinology, National Defense Medical College, 3-2 Namiki, 359-8513, Tokorozawa-shi, Saitama, Japan
| | - Isao Kurihara
- Department of Endocrinology, National Defense Medical College, 3-2 Namiki, 359-8513, Tokorozawa-shi, Saitama, Japan
| | - Hironori Shibata
- Department of Pediatrics, Keio University School of Medicine, Tokyo, Japan
| | - Tomohiro Ishii
- Department of Pediatrics, Keio University School of Medicine, Tokyo, Japan
| | - Tomonobu Hasegawa
- Department of Pediatrics, Keio University School of Medicine, Tokyo, Japan
| | - Hiroo Kumagai
- Department of Endocrinology, National Defense Medical College, 3-2 Namiki, 359-8513, Tokorozawa-shi, Saitama, Japan
| | - Akira Kasuga
- Department of Endocrinology, National Defense Medical College, 3-2 Namiki, 359-8513, Tokorozawa-shi, Saitama, Japan
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Yin M, Yang J, Tian Q, Zhang X. Ovarian gonadoblastoma with dysgerminoma in a girl with 46,XX karyotype 17a-hydroxylase/17, 20-lyase deficiency: A case report and literature review. Front Endocrinol (Lausanne) 2022; 13:989695. [PMID: 36589847 PMCID: PMC9797587 DOI: 10.3389/fendo.2022.989695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Accepted: 11/30/2022] [Indexed: 12/23/2022] Open
Abstract
17α-hydroxylase/17,20-lyase deficiency (17-OHD), caused by mutations in the gene of the cytochrome P450 family 17 subfamily A member 1 (CYP17A1), is a rare type of congenital adrenal hyperplasia (CAH), usually characterized by cortisol and sex steroid deficiency combined with excessive mineralocorticoid. Gonadoblastoma is a relatively rare ovarian tumor that is frequently seen among patients with 46,XY gonadal dysgenesis. Rarely have they been reported in female patients with normal 46,XX karyotype. Here, we report an interesting case of an 11-year-old Chinese girl who presented acute abdominal pain that was later attributed to tumor rupture of right ovarian gonadoblastoma with dysgerminoma. Further evaluations revealed hypertension and hypokalemia. Hormonal findings showed increased progesterone, hypergonadotropic hypogonadism, and low cortisol levels. Her chromosome karyotype was 46,XX without Y chromosome material detected. Genetic analysis revealed that the patient had a homozygous pathogenic variant c.985_987delTACinsAA (p.Y329Kfs*90) in exon 6 of the CYP17A1 gene and that her parents were all heterozygous carriers of this pathogenic variant. Due to the variable clinical manifestations of 17-OHD, meticulous assessment including genetic analysis is necessary. Further study is warranted to unravel the mechanism of gonadoblastoma in a patient with normal karyotypes.
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Dai LZ, Ma H, Ke JF, Lin CS, Huang Y, Tian Y, Chen D. A rare case of 17α-hydroxylase/17, 20-lyase deficiency: Clinical and genetic findings and follow-up outcomes. WOMEN'S HEALTH (LONDON, ENGLAND) 2022; 18:17455057221122597. [PMID: 36129002 PMCID: PMC9502244 DOI: 10.1177/17455057221122597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Revised: 07/23/2022] [Accepted: 08/02/2022] [Indexed: 11/17/2022]
Abstract
Here, we reported a case of a 16-year-old Chinese female patient (46, XX) diagnosed as 17α-hydroxylase/17, 20-lyase deficiency (17-OHD) in June 2018 and over 3 years follow-up outcomes; 17-OHD is a rare form of congenital adrenal hyperplasia. The patient presented with primary amenorrhea, underdeveloped secondary sexual characteristics, hypertension and hypokalemia. Hormonal findings revealed decreased estrogen and androgen, increased progesterone, low cortisol concentration and compensatory high adrenocorticotropic hormone level. Mutation analysis of the CYP17A1 gene identified the c.1459_1467del GACTCTTTC homozygous deletion in exon 8, namely, D487_F489del mutation, resulting in the deletion of Aspartate-Serine-Phenylalanine amino acids. The patient's father and mother were all heterozygous carriers of this mutation. The diagnosis and follow-up outcomes provided useful insights to support clinical decision-making and appropriate treatment.
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Affiliation(s)
- Li-Zhen Dai
- Department of Endocrinology, The Third Clinical Medical College of Fujian Medical University, Xiamen, China
| | - Hong Ma
- Department of Endocrinology, The Third Clinical Medical College of Fujian Medical University, Xiamen, China
- Department of Endocrinology, Zhongshan Hospital Xiamen University, Xiamen, China
| | - Jian-Fang Ke
- Department of Endocrinology, The Third Clinical Medical College of Fujian Medical University, Xiamen, China
| | - Chen-Shi Lin
- Department of Endocrinology, Zhongshan Hospital Xiamen University, Xiamen, China
| | - Yanling Huang
- Department of Endocrinology, The Third Clinical Medical College of Fujian Medical University, Xiamen, China
- Department of Endocrinology, Zhongshan Hospital Xiamen University, Xiamen, China
| | - Yuan Tian
- Department of Endocrinology, Zhongshan Hospital Xiamen University, Xiamen, China
| | - Danling Chen
- Department of Endocrinology, Zhongshan Hospital Xiamen University, Xiamen, China
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