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Ikeya A, Yamashita M, Kakizawa K, Kawauchi Y, Matsushita A, Fujisawa Y, Ogata T, Sasaki S. A Case of 17α-hydroxylase/17,20-lyase Deficiency Diagnosed at 45 Years of Age with Hyperaldosteronism. Intern Med 2024:3084-23. [PMID: 38599871 DOI: 10.2169/internalmedicine.3084-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/12/2024] Open
Abstract
17α-hydroxylase deficiency is a type of congenital adrenocortical hyperplasia that is typically diagnosed in childhood or adolescence. It manifests as hypertension with gonadal dysfunction as the primary symptom. We herein report 17α-hydroxylase/17,20-lyase deficiency (17OHD) diagnosed at the age of 45 years. The patient presented with hypertension, irregular menstruation, and hyperaldosteronism. The clinical manifestations of 17OHD vary based on the specific variant pattern of CYP17A1. In this case, the variant was c.157_159 TCC del p. Phe53del, which has been frequently reported in Japan. The enzymatic deficiency due to this variant is partial, leading to a delay in making a correct diagnosis.
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Affiliation(s)
- Akira Ikeya
- 2nd Department of Internal Medicine, Hamamatsu University School of Medicine, Japan
- Department of Internal Medicine, Futagawa Hospital, Japan
| | - Miho Yamashita
- International Center, Hamamatsu University School of Medicine, Japan
| | - Keisuke Kakizawa
- 2nd Department of Internal Medicine, Hamamatsu University School of Medicine, Japan
| | - Yuto Kawauchi
- 2nd Department of Internal Medicine, Hamamatsu University School of Medicine, Japan
| | - Akio Matsushita
- 2nd Department of Internal Medicine, Hamamatsu University School of Medicine, Japan
| | - Yasuko Fujisawa
- Department of Pediatrics, Hamamatsu University School of Medicine, Japan
| | - Tsutomu Ogata
- Department of Pediatrics, Hamamatsu University School of Medicine, Japan
- Department of Biochemistry, Hamamatsu University School of Medicine, Japan
| | - Shigekazu Sasaki
- 2nd Department of Internal Medicine, Hamamatsu University School of Medicine, Japan
- Department of Diabetes and Endocrinology, Nagoya City University Mirai Kousei Hospital, Japan
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Pan P, Zheng L, Huang J, Chen X, Ni R, Zhang Q, Yang D, Li Y. Endocrine profiles and cycle characteristics of infertile 17α-hydroxylase/17,20-lyase Deficiency Patients undergoing assisted Reproduction Treatment: a retrospective cohort study. J Ovarian Res 2023; 16:111. [PMID: 37316894 DOI: 10.1186/s13048-023-01190-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Accepted: 05/18/2023] [Indexed: 06/16/2023] Open
Abstract
BACKGROUND 17α-hydroxylase/17,20-lyase deficiency (17-OHD) is a rare form of congenital adrenal hyperplasia caused by CYP17A1 gene variants. Female patients with 17-OHD demonstrate a broad clinical spectrum, including oligomenorrhea or amenorrhea and infertility, often as the sole manifestation. However, no spontaneous pregnancies in affected women have been reported. OBJECTIVE This retrospective cohort study aimed to explore the endocrine characteristics and assisted reproductive technique (ART) performance in women with 17-OHD. METHODS Five women were referred for primary infertility in a university-affiliated hospital over an eight-year period. The endocrine profiles and cycle characteristics during a total of nine cycles of ovarian stimulation and eight cycles of frozen-thawed embryo transfer (FET) were described in details. RESULTS Three cases had homozygous variants and two cases had compound heterozygous variants, including one novel missense variant (p.Leu433Ser) in the CYP17A1 gene. Despite dual-suppression of progesterone (P) production by glucocorticoid and gonadotropin releasing hormone agonist, gradually increased P level, relatively low estradiol concentrations and thin endometrium were observed, negating fresh embryo transfer. During FET cycles, appropriate treatment resulted in low serum P levels and adequate endometrial thickness, leading to four live births. CONCLUSIONS Our findings demonstrate that continuous elevation of serum P during follicular growth impairs endometrial receptivity, the likely cause of female infertility in 17-OHD. Therefore, female infertility caused by 17-OHD is suggested as an indication for freeze-all strategy, with promising reproductive prognoses following segmented ovarian stimulation and FET treatment.
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Affiliation(s)
- Ping Pan
- Reproductive Medicine Centre, Department of Obstetrics and Gynecology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, 107 West Yan Jiang Road, Guangzhou, 510120, Guangdong, China
| | - Lingyan Zheng
- Reproductive Medicine Centre, Department of Obstetrics and Gynecology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, 107 West Yan Jiang Road, Guangzhou, 510120, Guangdong, China
| | - Jia Huang
- Reproductive Medicine Centre, Department of Obstetrics and Gynecology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, 107 West Yan Jiang Road, Guangzhou, 510120, Guangdong, China
| | - Xiaoli Chen
- Reproductive Medicine Centre, Department of Obstetrics and Gynecology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, 107 West Yan Jiang Road, Guangzhou, 510120, Guangdong, China
| | - Renmin Ni
- Department of Reproductive Medicine, Kunming Angel Women's and Children's Hospital, Kunming, Yunnan, China
| | - Qingxue Zhang
- Reproductive Medicine Centre, Department of Obstetrics and Gynecology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, 107 West Yan Jiang Road, Guangzhou, 510120, Guangdong, China
| | - Dongzi Yang
- Reproductive Medicine Centre, Department of Obstetrics and Gynecology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, 107 West Yan Jiang Road, Guangzhou, 510120, Guangdong, China.
| | - Yu Li
- Reproductive Medicine Centre, Department of Obstetrics and Gynecology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, 107 West Yan Jiang Road, Guangzhou, 510120, Guangdong, China.
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Li Y, Han T, Wang Y, Gao J, Zhang J, Wu Y. Clinical and Genetic Analyses of Two Unrelated 46, XX Girls with Combined 17α-Hydroxylase/17,20-lyase Deficiency from China. J Clin Res Pediatr Endocrinol 2023. [PMID: 36800681 DOI: 10.4274/jcrpe.galenos.2023.2022-8-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/21/2023] Open
Abstract
The cytochrome P450 17α-hydroxylase (P450c17) enzyme, encoded by Cytochrome P450 Family 17 Subfamily A Member 1 (CYP17A1) gene, catalyzes both the 17a-hydroxylation and 17,20-lyase reactions required for the production of cortisol and sex steroids. 17α-hydroxylase/17,20-lyase deficiency (17OHD) is a rare autosomal recessive disease caused by homozygous or compound heterozygous mutations in CYP17A1 gene. 17OHD can be classified into complete form and partial form based on the phenotypes resulting from P450c17 enzyme defects of different severities. Here we report two unrelated girls diagnosed with 17OHD at the age of 15 and 16 respectively. Both patients presented with primary amenorrhea, infantile female external genitalia and absent axillary or pubic hair. Hypergonadotropic hypogonadism was detected in both patients. Besides, Case 1 showed undeveloped breast, primary nocturnal enuresis, hypertension, hypokalemia and reduced 17α-hydroxyprogesterone and cortisol levels, while Case 2 had growth spurt, spontaneous breast development, elevated corticosterone and decreased aldosterone. The chromosome karyotype for both patients was 46, XX. Clinical exome sequencing was used to detect the underlying genetic defect in the patients, and the potential pathogenic mutations were validated by Sanger sequencing of the patients and their parents. The homozygous p.S106P mutation of CYP17A1 gene detected in Case 1 has been reported previously. Although the p.R347C and p.R362H mutations have been reported separately before, their compound heterozygote was firstly identified in Case 2. Based on the clinical, laboratory and genetic findings, Case 1 and Case 2 were definitely diagnosed as complete and partial form of 17OHD respectively. Both patients received estrogen and glucocorticoid replacement therapy. Their uterus and breasts developed gradually, and first menstruation occurred. Hypertension, hypokalemia and nocturnal enuresis in Case 1 were relieved. In conclusion, we described a case of complete 17OHD accompanied by nocturnal enuresis for the first time. Moreover, we identified a new compound heterozygote (p.R347C and p.R362H) of CYP17A1 gene in the case with partial 17OHD.
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Affiliation(s)
- Yamei Li
- Department of Women Health Care, Hunan Provincial Maternal and Child Health Care Hospital
- NHC Key Laboratory for Birth Defect for Research and Prevention, Hunan Provincial Maternal and Child Health Care Hospital
| | - Ting Han
- Department of Women Health Care, Hunan Provincial Maternal and Child Health Care Hospital
| | - Yingxia Wang
- Department of Women Health Care, Hunan Provincial Maternal and Child Health Care Hospital
| | - Jie Gao
- Department of Women Health Care, Hunan Provincial Maternal and Child Health Care Hospital
| | - Jianglin Zhang
- Department of Women Health Care, Hunan Provincial Maternal and Child Health Care Hospital
| | - Yinglan Wu
- Department of Women Health Care, Hunan Provincial Maternal and Child Health Care Hospital
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Yamagata S, Kageyama K, Usui T, Saito K, Takayasu S, Usutani M, Terui K, Daimon M. Identification of a homozygous c.1039C>T (p.R347C) variant in CYP17A1 in a 67-year-old female patient with partial 17α-hydroxylase/17,20-lyase deficiency. Endocr J 2022; 69:115-120. [PMID: 34483146 DOI: 10.1507/endocrj.ej21-0266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
17α-Hydroxylase/17,20-lyase deficiency (17OHD) is caused by pathogenic mutations in CYP17A1. Impaired 17α-hydroxylase and 17,20-lyase activities typically induce hypertension, hypokalemia, sexual infantilism, and amenorrhea. Most patients with 17OHD are diagnosed in adolescence. Here, we report a female (46, XX) patient with 17OHD who was diagnosed at the age of 67 years. Genetic analysis was performed using direct DNA sequencing of polymerase chain reaction (PCR) products and multiplex ligation-dependent probe amplification (MLPA) analysis. Direct DNA sequencing revealed a homozygous c.1039C>T in CYP17A1, corresponding to a p.R347C amino acid change. MLPA probe signals showed that the CYP17A1 mutation was present in the homozygous carrier state. The patient's dehydroepiandrosterone sulfate and androstenedione levels were extremely low, despite elevated adrenocorticotropic hormone (ACTH) and normal cortisol levels. A corticotropin-releasing hormone (CRH) test showed no response of cortisol, despite a normal response of ACTH. Rapid ACTH injection resulted in elevations in the deoxycorticosterone, corticosterone, aldosterone, and 17-hydroxypregnenolone levels, but not in the cortisol level. These results suggested that 17α-hydroxylase/17,20-lyase activities were partially impaired. Computed tomography revealed bilateral adrenal hyperplasia and a hypoplastic uterus. A high basal plasma ACTH level and a discrepancy between ACTH and cortisol responses in a CRH test may provide a definitive diagnostic clue for this disease.
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Affiliation(s)
- Satoshi Yamagata
- Department of Endocrinology and Metabolism, Hirosaki University Graduate School of Medicine, Hirosaki 036-8562, Japan
| | - Kazunori Kageyama
- Department of Endocrinology and Metabolism, Hirosaki University Graduate School of Medicine, Hirosaki 036-8562, Japan
| | - Takeshi Usui
- Department of Medical Genetics, Shizuoka General Hospital, Shizuoka 420-8527, Japan
- Shizuoka Graduate University of Public Health, Shizuoka 420-0881, Japan
| | - Kohei Saito
- Department of Medical Genetics, Shizuoka General Hospital, Shizuoka 420-8527, Japan
| | - Shinobu Takayasu
- Department of Endocrinology and Metabolism, Hirosaki University Graduate School of Medicine, Hirosaki 036-8562, Japan
| | - Mari Usutani
- Department of Endocrinology and Metabolism, Hirosaki University Graduate School of Medicine, Hirosaki 036-8562, Japan
| | - Ken Terui
- Department of Endocrinology and Metabolism, Hirosaki University Graduate School of Medicine, Hirosaki 036-8562, Japan
| | - Makoto Daimon
- Department of Endocrinology and Metabolism, Hirosaki University Graduate School of Medicine, Hirosaki 036-8562, Japan
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Chen H, Yuan K, Zhang B, Jia Z, Chen C, Zhu Y, Sun Y, Zhou H, Huang W, Liang L, Yan Q, Wang C. A Novel Compound Heterozygous CYP17A1 Variant Causes 17α-Hydroxylase/17, 20-Lyase Deficiency. Front Genet 2019; 10:996. [PMID: 31695722 PMCID: PMC6817513 DOI: 10.3389/fgene.2019.00996] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Accepted: 09/18/2019] [Indexed: 12/16/2022] Open
Abstract
Background: Congenital adrenal hyperplasia (CAH) encompasses a group of autosomal recessive diseases characterized by enzyme deficiencies, within steroid hormone anabolism, which lead to disorders in cortisol synthesis. The 17α-hydroxylase/17,20-lyase deficiency (17-OHD) is an uncommon form of CAH caused by variants in the CYP17A1 gene. Aims: We report a novel compound heterozygous CYP17A1 variant and its association with the pathogenesis of 17-OHD. Methods: The patient was assessed for medical history, clinical manifestations, physical examination, laboratory examination, karyotype analysis, and adrenal computed tomography. Mutation screening was conducted using whole-exome sequencing (WES) and Sanger sequencing. The wild-type and mutant CYP17A1 complementary DNAs (cDNAs) were amplified and cloned into a pcDNA3.1(+) vector. These plasmids were transfected transiently into HEK-293T cells. Quantitative PCR and Western blotting analysis were performed to measure the expression level of P450c17. An enzymatic activity assay was conducted to measure the content of 17-hydroxyprogesterone (17-OHP) and dehydroepiandrosterone (DHEA) in medium using liquid chromatography–tandem mass spectrometry (LC-MS/MS). Results: The proband was characterized by 17-OHD with rhabdomyolysis, hypokalemia, and adrenal insufficiency. Novel compound heterozygous variants of the CYP17A1 gene (c.1304T > C/p.Phe435Ser and c.1228delG/p.Asp410Ilefs*9) were identified. The enzymatic activity assay revealed that this variant resulted in a complete deficiency of 17α-hydroxylase and 17,20-lyase activity. This was consistent with the hormonal characteristics of the proband’s blood. Conclusions: These results suggest that the compound heterozygous variant of c.1304T > C and c.1228delG of the CYP17A1 gene can lead to 17-OHD. Our findings thus provide a novel insight into the clinical evaluations and molecular basis of 17-OHD.
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Affiliation(s)
- Hong Chen
- Department of Pediatrics, The First Affiliated Hospital, College of Medicine Zhejiang University, Hangzhou, China
| | - Ke Yuan
- Department of Pediatrics, The First Affiliated Hospital, College of Medicine Zhejiang University, Hangzhou, China
| | - Bingtao Zhang
- College of Life Science, Zhejiang University, Hangzhou, China
| | - Zexiao Jia
- College of Life Science, Zhejiang University, Hangzhou, China
| | - Chun Chen
- Department of Pediatrics, The First Affiliated Hospital, College of Medicine Zhejiang University, Hangzhou, China
| | - Yilin Zhu
- Department of Pediatrics, The First Affiliated Hospital, College of Medicine Zhejiang University, Hangzhou, China
| | - Yaping Sun
- College of Life Science, Zhejiang University, Hangzhou, China
| | - Hui Zhou
- College of Life Science, Zhejiang University, Hangzhou, China
| | - Wendong Huang
- Department of Diabetes Complications and Metabolism, The Beckman Research Institute, City of Hope National Medical Center, Duarte, CA, United States
| | - Li Liang
- Department of Pediatrics, The First Affiliated Hospital, College of Medicine Zhejiang University, Hangzhou, China
| | - Qingfeng Yan
- Department of Pediatrics, The First Affiliated Hospital, College of Medicine Zhejiang University, Hangzhou, China.,College of Life Science, Zhejiang University, Hangzhou, China.,Key Laboratory for Cell and Gene Engineering of Zhejiang Province, Hangzhou, China
| | - Chunlin Wang
- Department of Pediatrics, The First Affiliated Hospital, College of Medicine Zhejiang University, Hangzhou, China
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Abstract
BACKGROUNDS 17α-hydroxylase/17,20-lyase deficiency (17-OHD) is an uncommon form of congenital adrenal hyperplasia. Most patients are tall owing to delayed closure of epiphyses as a result of deficiency of sex hormones. METHODS We present a 17-OHD case with unusual short stature and reviewed related literature. RESULTS A 17-year-old female patient presented with primary amenorrhea, hypertension, hypokalemia and hypergonadotropic hypogonadism (HH). Sequencing of the CYP17A1 gene identified a homozygous c.985_987delTACinsAA in exon 6 that confirmed the diagnosis of 17-OHD. However, her height (148 cm, height standard deviation score [HSDS] -2.28) was unusually low compared with that of other 17-OHD patients. Levels of growth hormone (GH) and insulin-like growth factor (IGF)-1 were normal, and the GH provocation test excluded the possibility of GH deficiency. She underwent glucocorticoid and sex-hormone replacement therapy, reaching a final height of 152 cm (HSDS -1.59). These data suggest that tall stature is not a requisite characteristic of 17-OHD. Further studies are needed to clarify the effects of sex hormone on linear bone growth (LBG) in 17-OHD patients.
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Affiliation(s)
- Lizhen Ma
- a Department of Endocrinology and Metabolism , Hangzhou First People's Hospital, Nanjing Medical University , Hangzhou , PR China
| | - Fengying Peng
- a Department of Endocrinology and Metabolism , Hangzhou First People's Hospital, Nanjing Medical University , Hangzhou , PR China
| | - Lingying Yu
- a Department of Endocrinology and Metabolism , Hangzhou First People's Hospital, Nanjing Medical University , Hangzhou , PR China
| | - Jun Chen
- a Department of Endocrinology and Metabolism , Hangzhou First People's Hospital, Nanjing Medical University , Hangzhou , PR China
| | - Weiqin Ji
- a Department of Endocrinology and Metabolism , Hangzhou First People's Hospital, Nanjing Medical University , Hangzhou , PR China
| | - Chu Zhang
- a Department of Endocrinology and Metabolism , Hangzhou First People's Hospital, Nanjing Medical University , Hangzhou , PR China
| | - Xianfeng Zhang
- a Department of Endocrinology and Metabolism , Hangzhou First People's Hospital, Nanjing Medical University , Hangzhou , PR China
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Camats N, Üstyol A, Atabek ME, Dick B, Flück CE. A novel CYP17A1 deletion causes a functional knockout of the steroid enzyme 17-hydroxylase and 17,20-lyase in a Turkish family and illustrates the precise role of the CYP17A1 gene. Clin Case Rep 2015; 3:793-7. [PMID: 26509008 PMCID: PMC4614641 DOI: 10.1002/ccr3.343] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2015] [Revised: 05/29/2015] [Accepted: 07/29/2015] [Indexed: 11/10/2022] Open
Abstract
A novel homozygous long-range deletion of the CYP17A1 gene abolished protein expression and caused the severest form of 17-hydroxylase deficiency in one kindred of a Turkish family. The affected subjects presented with 46,XY sex reversal and 46,XX lack of pubertal development as well as severe hypertension.
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Affiliation(s)
- Núria Camats
- Pediatric Endocrinology and Diabetology, Departments of Pediatrics and Clinical Research, University Children's Hospital Bern Bern, 3010, Switzerland
| | - Ala Üstyol
- School of Medicine, Department of Pediatrics, Division of Pediatric Endocrinology and Diabetes, Necmettin Erbakan University Konya, 42080, Turkey
| | - Mehmet Emre Atabek
- School of Medicine, Department of Pediatrics, Division of Pediatric Endocrinology and Diabetes, Necmettin Erbakan University Konya, 42080, Turkey
| | - Bernhard Dick
- Department of Nephrology, Hypertension and Clinical Pharmacology, University Hospital Bern Bern, 3010, Switzerland
| | - Christa E Flück
- Pediatric Endocrinology and Diabetology, Departments of Pediatrics and Clinical Research, University Children's Hospital Bern Bern, 3010, Switzerland
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