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Galderisi A, Kariyawasam D, Stoupa A, Quoc AN, Pinto G, Viaud M, Brabant S, Beltrand J, Polak M, Samara-Boustani D. Glucose pattern in children with classical congenital adrenal hyperplasia: evidence from continuous glucose monitoring. Eur J Endocrinol 2023; 189:K19-K24. [PMID: 37952170 DOI: 10.1093/ejendo/lvad147] [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: 07/27/2023] [Revised: 10/01/2023] [Accepted: 10/16/2023] [Indexed: 11/14/2023]
Abstract
BACKGROUND While the risk for hypoglycemia during acute illness is well described in children with classical congenital adrenal hyperplasia (CAH), there is little evidence for the prevalence of asymptomatic hypoglycemia and the daily glucose patterns in CAH. Herein, we explored the daytime glucose profile of children with classical CAH. METHODS We conducted an observational study in 11 children (6 female; age 3.1 years [1.4, 5.1]; body mass index 17.3 kg/m2 [15.6, 17.9]) with a genetic diagnosis of classical CAH receiving hydrocortisone and fludrocortisone replacement therapy. Participants underwent 2 14-day continuous glucose monitoring (CGM) sessions and an inpatient 24 h series cortisol and adrenocorticotropic hormone (ACTH) measures. Data were analyzed for 3 daytime lags (7 Am-4 Pm, 4 Pm-10pm, 10 Pm-7 Am) corresponding to the hydrocortisone dosing period with cortisol and ACTH measured before the hydrocortisone dose. RESULTS Eleven participants completed at least 1 CGM session, and 7 out of 11 underwent both the CGM session and the cortisol/ACTH serial measures. In the whole cohort, the percentage of time of sensor glucose values <70 mg/dL was higher during the 10 Pm-7 Am and the 7 Am-4 Pm time slots than in the late afternoon period (17% [7, 54] and 15% [6.8, 24] vs 2% [1.1, 16.7] during the periods 7 Am-4 Pm and 4 Pm-10 Pm, respectively [P = .006 and P = .003]). Nighttime hypoglycemia was mostly spent below the 65 mg/dL (10.9% [4.1, 34]). The glycemic pattern paralleled the nadir of daily cortisol at 7 Am (10.3±4.4 μg/dL). A greater percentage of time in hypoglycemia was associated with lower cortisol concentration at 7 Am and 10 Pm (P < .001 and P = .005). CONCLUSIONS Continuous glucose monitoring demonstrated a disrupted daily glucose pattern in children with CAH, paralleled by a lower cortisol concentration. CLINICALTRIALS.GOV REGISTRATION NCT04322435.
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Affiliation(s)
- Alfonso Galderisi
- Department of Paediatric Endocrinology, Diabetology, and Gynaecology, Necker-Enfants Malades University Hospital, Centre de Référence des Maladies endocriniennes Rares de la Croissance et du Développement (filière FIRENDO), AP-HP Centre, Paris, France
- Department of Pediatrics, Pediatric Endocrinology, Yale University, New Haven, CT, United States
| | - Dulanjalee Kariyawasam
- Department of Paediatric Endocrinology, Diabetology, and Gynaecology, Necker-Enfants Malades University Hospital, Centre de Référence des Maladies endocriniennes Rares de la Croissance et du Développement (filière FIRENDO), AP-HP Centre, Paris, France
- Faculty of Medicine, Université Paris Cité, Paris, France
- Cochin Institute, INSERM U1016, Paris, France
- IMAGINE Institute Affiliate, INSERM U1163, Paris, France
| | - Athanasia Stoupa
- Department of Paediatric Endocrinology, Diabetology, and Gynaecology, Necker-Enfants Malades University Hospital, Centre de Référence des Maladies endocriniennes Rares de la Croissance et du Développement (filière FIRENDO), AP-HP Centre, Paris, France
- Faculty of Medicine, Université Paris Cité, Paris, France
- Cochin Institute, INSERM U1016, Paris, France
- IMAGINE Institute Affiliate, INSERM U1163, Paris, France
| | - Adrien Nguyen Quoc
- Department of Paediatric Endocrinology, Diabetology, and Gynaecology, Necker-Enfants Malades University Hospital, Centre de Référence des Maladies endocriniennes Rares de la Croissance et du Développement (filière FIRENDO), AP-HP Centre, Paris, France
- Faculty of Medicine, Université Paris Cité, Paris, France
| | - Graziella Pinto
- Department of Paediatric Endocrinology, Diabetology, and Gynaecology, Necker-Enfants Malades University Hospital, Centre de Référence des Maladies endocriniennes Rares de la Croissance et du Développement (filière FIRENDO), AP-HP Centre, Paris, France
| | - Magali Viaud
- Department of Paediatric Endocrinology, Diabetology, and Gynaecology, Necker-Enfants Malades University Hospital, Centre de Référence des Maladies endocriniennes Rares de la Croissance et du Développement (filière FIRENDO), AP-HP Centre, Paris, France
| | - Severine Brabant
- Department of Functional Explorations, Necker-Enfants Malades University Hospital, AP-HP Centre, Paris, France
| | - Jacques Beltrand
- Department of Paediatric Endocrinology, Diabetology, and Gynaecology, Necker-Enfants Malades University Hospital, Centre de Référence des Maladies endocriniennes Rares de la Croissance et du Développement (filière FIRENDO), AP-HP Centre, Paris, France
- Faculty of Medicine, Université Paris Cité, Paris, France
- Cochin Institute, INSERM U1016, Paris, France
- IMAGINE Institute Affiliate, INSERM U1163, Paris, France
| | - Michel Polak
- Department of Paediatric Endocrinology, Diabetology, and Gynaecology, Necker-Enfants Malades University Hospital, Centre de Référence des Maladies endocriniennes Rares de la Croissance et du Développement (filière FIRENDO), AP-HP Centre, Paris, France
- Faculty of Medicine, Université Paris Cité, Paris, France
- Cochin Institute, INSERM U1016, Paris, France
- IMAGINE Institute Affiliate, INSERM U1163, Paris, France
| | - Dinane Samara-Boustani
- Department of Paediatric Endocrinology, Diabetology, and Gynaecology, Necker-Enfants Malades University Hospital, Centre de Référence des Maladies endocriniennes Rares de la Croissance et du Développement (filière FIRENDO), AP-HP Centre, Paris, France
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Guo X, Zhang Y, Yu Y, Zhang L, Ullah K, Ji M, Jin B, Shu J. Corrigendum: Getting pregnant with congenital adrenal hyperplasia: assisted reproduction and pregnancy complications. A systematic review and meta-analysis. Front Endocrinol (Lausanne) 2023; 14:1269711. [PMID: 37842302 PMCID: PMC10575760 DOI: 10.3389/fendo.2023.1269711] [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] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Accepted: 08/04/2023] [Indexed: 10/17/2023] Open
Abstract
[This corrects the article DOI: 10.3389/fendo.2022.982953.].
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Affiliation(s)
- Xiaoyan Guo
- Center for Reproductive Medicine, Department of Reproductive Endocrinology, Zhejiang Provincial People’s Hospital, Affiliated People’s Hospital, Hangzhou Medical College, Hangzhou, China
| | - Yu Zhang
- School of Nursing, Hangzhou Medical College,
Hangzhou, China
| | - Yiqi Yu
- Center for Reproductive Medicine, Department of Reproductive Endocrinology, Zhejiang Provincial People’s Hospital, Affiliated People’s Hospital, Hangzhou Medical College, Hangzhou, China
| | - Ling Zhang
- Center for Reproductive Medicine, Department of Reproductive Endocrinology, Zhejiang Provincial People’s Hospital, Affiliated People’s Hospital, Hangzhou Medical College, Hangzhou, China
| | - Kamran Ullah
- Department of Biology, The University of Haripur, Haripur, Pakistan
| | - Mengxia Ji
- Center for Reproductive Medicine, Department of Reproductive Endocrinology, Zhejiang Provincial People’s Hospital, Affiliated People’s Hospital, Hangzhou Medical College, Hangzhou, China
| | - Bihui Jin
- Center for Reproductive Medicine, Department of Reproductive Endocrinology, Zhejiang Provincial People’s Hospital, Affiliated People’s Hospital, Hangzhou Medical College, Hangzhou, China
| | - Jing Shu
- Center for Reproductive Medicine, Department of Reproductive Endocrinology, Zhejiang Provincial People’s Hospital, Affiliated People’s Hospital, Hangzhou Medical College, Hangzhou, China
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Erratum: Getting pregnant with congenital adrenal hyperplasia: assisted reproduction and pregnancy complications. A systematic review and meta-analysis. Front Endocrinol (Lausanne) 2023; 14:1276185. [PMID: 37842296 PMCID: PMC10569454 DOI: 10.3389/fendo.2023.1276185] [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] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Accepted: 08/11/2023] [Indexed: 10/17/2023] Open
Abstract
[This corrects the article DOI: 10.3389/fendo.2022.982953.].
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Storbeck KH, O'Reilly MW. The clinical and biochemical significance of 11-oxygenated androgens in human health and disease. Eur J Endocrinol 2023; 188:R98-R109. [PMID: 37041725 DOI: 10.1093/ejendo/lvad047] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Accepted: 04/11/2023] [Indexed: 04/13/2023]
Abstract
For many decades, the prevailing paradigm in endocrinology was that testosterone and 5α-dihydrotestosterone (DHT) are the only potent androgens in the context of human physiology. The more recent identification of adrenal derived 11-oxygenated androgens and particularly, 11-ketotestosterone (11KT), have challenged these established norms, prompting a revaluation of the androgen pool, particularly in women. Since being recognised as bone fide androgens in humans, numerous studies have focussed their attention on understanding the role of 11-oxygenated androgens in human health and disease and have implicated them as role players in conditions such as castration resistant prostate cancer, congenital adrenal hyperplasia, polycystic ovary syndrome, Cushing's syndrome and premature adrenarche. This review therefore provides an overview of our current knowledge on the biosynthesis and activity of 11-oxygenated androgens with a focus on their role in disease states. We also highlight important analytical considerations for measuring this unique class of steroid hormone.
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Affiliation(s)
- Karl-Heinz Storbeck
- Department of Biochemistry, Stellenbosch University, Stellenbosch, South Africa
| | - Michael W O'Reilly
- Department of Medicine, Royal College of Surgeons in Ireland, University of Medicine and Health Sciences, Dublin, Ireland
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Lo CWS, Hoad K, Loh TP, van den Berg S, Cooke BR, Greaves RF, Hartmann MF, Wudy SA, Ho CS. Endogenous isobaric interference on serum 17 hydroxyprogesterone by liquid chromatography-tandem mass spectrometry methods. Clin Chem Lab Med 2023; 61:e64-e66. [PMID: 36457285 DOI: 10.1515/cclm-2022-1086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Accepted: 11/21/2022] [Indexed: 12/03/2022]
Affiliation(s)
- Clara Wai Shan Lo
- Biomedical Mass Spectrometry Unit, Department of Chemical Pathology, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, NT, Hong Kong
| | - Kirsten Hoad
- Department of Clinical Biochemistry, PathWest Laboratory Medicine, Fiona Stanley Hospital, Murdoch, Western Australia
| | - Tze Ping Loh
- Department of Laboratory Medicine, National University Hospital, Singapore
| | - Sjoerd van den Berg
- Department of Clinical Chemistry and Department of Internal Medicine, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Brian R Cooke
- Department of Clinical Biochemistry, PathWest Laboratory Medicine, Fiona Stanley Hospital, Murdoch, Western Australia
| | - Ronda F Greaves
- Victorian Clinical Genetics Services, Murdoch Children's Research Institute, Melbourne, VIC, Australia
| | - Michaela F Hartmann
- Steroid Research & Mass Spectrometry Unit of the Laboratory for Translational Hormone Analytics in Pediatric Endocrinology at the Justus Liebig University, Giessen, Germany
| | - Stefan A Wudy
- Steroid Research & Mass Spectrometry Unit of the Laboratory for Translational Hormone Analytics in Pediatric Endocrinology at the Justus Liebig University, Giessen, Germany
| | - Chung Shun Ho
- Biomedical Mass Spectrometry Unit, Department of Chemical Pathology, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, NT, Hong Kong
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Guo X, Zhang Y, Yu Y, Zhang L, Ullah K, Ji M, Jin B, Shu J. Getting pregnant with congenital adrenal hyperplasia: Assisted reproduction and pregnancy complications. A systematic review and meta-analysis. Front Endocrinol (Lausanne) 2022; 13:982953. [PMID: 36120452 PMCID: PMC9470834 DOI: 10.3389/fendo.2022.982953] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 08/08/2022] [Indexed: 11/13/2022] Open
Abstract
Many patients with congenital adrenal hyperplasia (CAH) refrain from seeking pregnancy, suffer from infertility or worry about pregnancy complications, mainly due to genitalia abnormalities, anovulation, unreceptive endometrium and metabolic disturbances. Despite those challenges, many live births have been reported. In this systematic review, we focused on the key to successful assisted reproduction strategies and the potential pregnancy complications. We did a systematic literature search of Pubmed, Medline and Scopus for articles reporting successful pregnancies in CAH other than 21-hydroxylase deficiency, and found 25 studies reporting 39 pregnancies covering deficiency in steroidogenic acute regulatory protein, 17α-hydroxylase/17,20-lyase, 11β-hydroxylase, P450 oxidoreductase, cytochrome b5 and 3β-hydroxysteroid dehydrogenase. We summarized various clinical manifestations and tailored reproduction strategy for each subtype. Furthermore, a meta-analysis was performed to evaluate the pregnancy complications of CAH patients. A total of 19 cross-sectional or cohort studies involving 1311 pregnancies of classic and non-classic CAH patients were included. Surprisingly, as high as 5.5% (95% CI 2.3%-9.7%) of pregnancies were electively aborted, and the risk was significantly higher in those studies with a larger proportion of classic CAH than those with only non-classical patients (8.43% (4.1%-13.81%) VS 3.75%(1.2%-7.49%)), which called for better family planning. Pooled incidence of miscarriage was 18.2% (13.4%-23.4%) with a relative risk (RR) of 1.86 (1.27-2.72) compared to control. Glucocorticoid treatment in non-classical CAH patients significantly lowered the miscarriage rate when compared to the untreated group (RR 0.25 (0.13-0.47)). CAH patients were also more susceptible to gestational diabetes mellitus, with a prevalence of 7.3% (2.4%-14.1%) and a RR 2.57 (1.29-5.12). However, risks of preeclampsia, preterm birth and small for gestational age were not significantly different. 67.8% (50.8%-86.9%) CAH patients underwent Cesarean delivery, 3.86 (1.66-8.97) times the risk of the control group. These results showed that fertility is possible for CAH patients but special care was necessary when planning, seeking and during pregnancy. Systematic Review Registration PROSPERO https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=342642, CRD42022342642.
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Affiliation(s)
- Xiaoyan Guo
- Center for Reproductive Medicine, Department of Reproductive Endocrinology, Zhejiang Provincial People’s Hospital, Affiliated People’s Hospital, Hangzhou Medical College, Hangzhou, China
| | - Yu Zhang
- School of Nursing, Hangzhou Medical College, Hangzhou, China
| | - Yiqi Yu
- Center for Reproductive Medicine, Department of Reproductive Endocrinology, Zhejiang Provincial People’s Hospital, Affiliated People’s Hospital, Hangzhou Medical College, Hangzhou, China
| | - Ling Zhang
- Center for Reproductive Medicine, Department of Reproductive Endocrinology, Zhejiang Provincial People’s Hospital, Affiliated People’s Hospital, Hangzhou Medical College, Hangzhou, China
| | - Kamran Ullah
- Department of Biology, The University of Haripur, Haripur, Pakistan
| | - Mengxia Ji
- Center for Reproductive Medicine, Department of Reproductive Endocrinology, Zhejiang Provincial People’s Hospital, Affiliated People’s Hospital, Hangzhou Medical College, Hangzhou, China
| | - Bihui Jin
- Center for Reproductive Medicine, Department of Reproductive Endocrinology, Zhejiang Provincial People’s Hospital, Affiliated People’s Hospital, Hangzhou Medical College, Hangzhou, China
| | - Jing Shu
- Center for Reproductive Medicine, Department of Reproductive Endocrinology, Zhejiang Provincial People’s Hospital, Affiliated People’s Hospital, Hangzhou Medical College, Hangzhou, China
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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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Matusik P, Gach A, Zajdel-Cwynar O, Pinkier I, Kudela G, Gawlik A. A Novel Intronic Splice-Site Mutation of the CYP11A1 Gene Linked to Adrenal Insufficiency with 46,XY Disorder of Sex Development. Int J Environ Res Public Health 2021; 18:ijerph18137186. [PMID: 34281122 PMCID: PMC8295740 DOI: 10.3390/ijerph18137186] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Revised: 06/30/2021] [Accepted: 07/01/2021] [Indexed: 12/02/2022]
Abstract
A novel CYP11A1: c.1236 + 5G > A was identified, expanding the mutation spectrum of the congenital adrenal insufficiency with 46,XY sex reversal. In a now 17-year-old girl delivered full-term (G2P2, parents unrelated), adrenal failure was diagnosed in the first year of life based on clinical picture of acute adrenal crisis with vomiting, dehydration, weight loss, hypotension, and electrolyte disturbances. At the time, hormonal tests revealed primary adrenocortical insufficiency and steroid profiles showed lack of products of steroidogenesis, and since then the patient has been treated with substitution doses of hydrocortisone and fludrocortisone. At the age of 14, considering the absence of puberty symptoms, extended diagnostic tests revealed elevated LH levels (26.5 mIU/mL) with pre-puberty FSH levels (4.9 mIU/mL), low estradiol (28 pmol/L), testosterone (<2.5 ng/mL), and extremely high levels of ACTH (4961 pg/mL). A cytogenetic study revealed a 46 XY karyotype. A molecular examination confirmed the missense mutation and a novel splice-site mutation of CYP11A1 gene. Compound heterozygosity for the CYP11A1 gene with a known pathogenic variant in one allele and a novel splice site mutation in the second allele is most probably responsible for congenital adrenal insufficiency with 46,XY sex reversal. We discuss the necessity of cytogenetic test in the case of early onset of adrenal failure in the absence of steroidogenesis metabolites in the steroid profile.
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Affiliation(s)
- Pawel Matusik
- Department of Pediatrics and Pediatric Endocrinology, Faculty of Medical Sciences in Katowice, Medical University of Silesia, 40-752 Katowice, Poland;
- Correspondence: ; Tel.: +48-32-207-1654
| | - Agnieszka Gach
- Department of Genetics, Polish Mother’s Memorial Hospital Research Institute, 93-338 Lodz, Poland; (A.G.); (I.P.)
| | | | - Iwona Pinkier
- Department of Genetics, Polish Mother’s Memorial Hospital Research Institute, 93-338 Lodz, Poland; (A.G.); (I.P.)
| | - Grzegorz Kudela
- Department of Pediatric Surgery and Urology, Faculty of Medical Sciences in Katowice, Medical University of Silesia, 40-752 Katowice, Poland;
| | - Aneta Gawlik
- Department of Pediatrics and Pediatric Endocrinology, Faculty of Medical Sciences in Katowice, Medical University of Silesia, 40-752 Katowice, Poland;
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Corcioni B, Renzulli M, Marasco G, Baronio F, Gambineri A, Ricciardi D, Ortolano R, Farina D, Gaudiano C, Cassio A, Pagotto U, Golfieri R. Prevalence and ultrasound patterns of testicular adrenal rest tumors in adults with congenital adrenal hyperplasia. Transl Androl Urol 2021; 10:562-573. [PMID: 33718059 PMCID: PMC7947447 DOI: 10.21037/tau-20-998] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Background Testicular adrenal rest tumors (TARTs) are benign neoplasms affecting patients with congenital adrenal hyperplasia (CAH). The prevalence of TART in adult patients with CAH is not well known. Ultrasonography (US) is the main tool for diagnosing TART and the role of contrast-enhanced US (CEUS) is never investigated. The aim of this study was to evaluate the TART prevalence in adults with CAH, by stratifying patients according to disease phenotype and assessing the diagnostic performance of US, color Doppler (CD) US and CEUS. Methods Male patients >16 years old with certain diagnosis of CAH who underwent US for TARTs, between December 2015 and September 2019 were prospectively enrolled. The control group included patients without CAH affected by testicular lesions at US other than TARTs. Results TARTs were identified in 16 of 52 patients (31%), of whom 15 (93.8%) displayed the salt-wasting (SW) form (P<0.001). The prevalence of TARTs in patients with the SW form was 54%. One patient with the non-classic (NC) form (6%) showed TART (likely the first documented case). The mean age of patients upon detection of TARTs was significantly younger compared with the control group (P<0.001); moreover, TARTs were bilateral in 15/16 patients (93.8%; P<0.001) and the largest lesion was more frequent in the medium third of testis in the TART group (87.5%), statistically different from the control group (P=0.013). Conclusions TARTs almost exclusively affected patients with the SW form of CAH. Age at diagnosis and bilateralism are useful factors for achieving a correct diagnosis of TARTs in CAH adult patients.
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Affiliation(s)
- Beniamino Corcioni
- Department of Radiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Matteo Renzulli
- Department of Radiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Giovanni Marasco
- Department of Medical and Surgical Sciences, S. Orsola Hospital, University of Bologna, Bologna, Italy
| | - Federico Baronio
- Pediatric Unit, Department of Medical and Surgical Sciences, S. Orsola Hospital, University of Bologna, Bologna, Italy
| | - Alessandra Gambineri
- Division of Endocrinology and Diabetes Prevention and Care, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy.,Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Domenico Ricciardi
- Department of Radiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Rita Ortolano
- Pediatric Unit, Department of Medical and Surgical Sciences, S. Orsola Hospital, University of Bologna, Bologna, Italy
| | - Davide Farina
- Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Caterina Gaudiano
- Department of Radiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Alessandra Cassio
- Pediatric Unit, Department of Medical and Surgical Sciences, S. Orsola Hospital, University of Bologna, Bologna, Italy
| | - Uberto Pagotto
- Division of Endocrinology and Diabetes Prevention and Care, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy.,Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Rita Golfieri
- Department of Radiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
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Verhees MJM, Engels M, Span PN, Sweep FCGJ, van Herwaarden AE, Falhammar H, Nordenström A, Webb EA, Richter-Unruh A, Bouvattier C, de la Perrière AB, Arlt W, Reisch N, Köhler B, Rapp M, Stikkelbroeck NMML, Roeleveld N, Claahsen-van der Grinten HL. Quality of Life in Men With Congenital Adrenal Hyperplasia Due to 21-Hydroxylase Deficiency. Front Endocrinol (Lausanne) 2021; 12:626646. [PMID: 33815285 PMCID: PMC8018222 DOI: 10.3389/fendo.2021.626646] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Accepted: 02/17/2021] [Indexed: 11/22/2022] Open
Abstract
Congenital adrenal hyperplasia (CAH) due to 21-hydroxylase deficiency (21OHD) is a disorder of adrenal steroid biosynthesis, leading to hypocortisolism, hypoaldosteronism, and hyperandrogenism. Impaired quality of life (QoL) has been demonstrated in women with CAH, but data on men with CAH are scarce. We hypothesized that disease severity and poor treatment control are inversely associated with QoL. In this study, 109 men (16-68 years) with 21OHD were included. The WHOQOL-BREF questionnaire was used to measure self-reported QoL domain scores on a 0-100 scale, where higher scores reflect better QoL. QoL domain scores were compared to published data on healthy and chronically ill reference populations from France, Germany, the Netherlands, and the United Kingdom. Differences in QoL scores among groups of disease severity and treatment control were tested within the study population. Overall, the men with CAH in this study appeared to rate their QoL as good. Median domain scores were 78.6 (IQR: 67.9-85.7) for physical health, 79.2 (IQR: 66.7-87.5) for psychological health, 75.0 (IQR: 58.3-83.3) for social relationships, and 81.3 (IQR: 71.9-90.6) for environment. In general, these scores were similar to WHOQOL-BREF domain scores in healthy references and higher compared to chronically ill reference populations. The domain scores did not differ among genotype groups, but patients with undertreatment or increased 17-hydroxyprogestrone concentrations scored higher on several QoL domains (p<0.05). Patients treated with dexamethasone or prednisone scored higher on the physical health, psychological health, and social relationships domains, but not on the environmental domain. In conclusion, QoL domain scores appeared to be comparable to healthy reference populations and higher compared to patients with a chronic illness. QoL was not influenced by genotype, but undertreatment and use of dexamethasone or prednisone were associated with higher QoL.
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Affiliation(s)
- Myrthe J. M. Verhees
- Department of Pediatrics, Amalia Children's Hospital, Radboud University Medical Center, Nijmegen, Netherlands
| | - Manon Engels
- Department of Pediatrics, Amalia Children's Hospital, Radboud University Medical Center, Nijmegen, Netherlands
- Department of Laboratory Medicine, Radboud Institute for Molecular Life Sciences (RIMLS), Radboud University Medical Center, Nijmegen, Netherlands
| | - Paul N. Span
- Radiotherapy and OncoImmunology Laboratory, Department of Radiation Oncology, Radboud Institute for Molecular Life Sciences (RIMLS), Radboud University Medical Center, Nijmegen, Netherlands
| | - Fred C. G. J. Sweep
- Department of Laboratory Medicine, Radboud Institute for Molecular Life Sciences (RIMLS), Radboud University Medical Center, Nijmegen, Netherlands
| | - Antonius E. van Herwaarden
- Department of Laboratory Medicine, Radboud Institute for Molecular Life Sciences (RIMLS), Radboud University Medical Center, Nijmegen, Netherlands
| | - Henrik Falhammar
- Department of Molecular Medicine and Surgery, Karolinska Institute, Stockholm, Sweden
- Department of Endocrinology, Metabolism and Diabetes, Karolinska University Hospital, Stockholm, Sweden
| | - Anna Nordenström
- Department of Women’s and Children’s Health, Division of Pediatric Endocrinology, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Emma A. Webb
- Centre for Endocrinology, Diabetes and Metabolism, Birmingham Health Partners, Birmingham, United Kingdom
- Institute of Metabolism and Systems Research (IMSR), University of Birmingham, Birmingham, United Kingdom
| | - Annette Richter-Unruh
- Sektion Kinderendokrinologie und Diabetologie, Klinik für Kinder- und Jugendmedizin der Ruhr-Universität Bochum im St. Josef-Hospital, Bochum, Germany
| | - Claire Bouvattier
- Endocrinologie Pédiatrique, Centre de Référence des Maladies Rares du Développement Sexuel, Hôpital Bicêtre, Université Paris-Sud, Le Kremlin-Bicêtre, France
| | - Aude Brac de la Perrière
- Fédération d’Endocrinologie, Centre de Référence des Maladies Rares du Développement Génital, Groupement Hospitalier Est, Hopital Louis Pradel, Bron, France
| | - Wiebke Arlt
- Centre for Endocrinology, Diabetes and Metabolism, Birmingham Health Partners, Birmingham, United Kingdom
- Institute of Metabolism and Systems Research (IMSR), University of Birmingham, Birmingham, United Kingdom
| | - Nicole Reisch
- Medizinische Klinik IV, Klinikum der Universität München, München, Germany
| | - Birgit Köhler
- Klinik für Pädiatrie m.S. Endokrinologie und Diabetologie, Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Marion Rapp
- Klinik fur Kinder- und Jugendmedizin, Universitat zu Lubeck, Lubeck, Germany
| | - Nike M. M. L. Stikkelbroeck
- Department of Internal Medicine, Division of Endocrinology, Radboud University Medical Center, Nijmegen, Netherlands
| | - Nel Roeleveld
- Department for Health Evidence, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, Netherlands
| | - Hedi L. Claahsen-van der Grinten
- Department of Pediatrics, Amalia Children's Hospital, Radboud University Medical Center, Nijmegen, Netherlands
- *Correspondence: Hedi L. Claahsen-van der Grinten,
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Reihani-Sabet F, Eftekhari-Yazdi P, Boroujeni PB, Saffari JR, Almadani N, Boloori S, Zamanian MR. Birth of a healthy boy following preimplantation genetic diagnosis for congenital adrenal hyperplasia. JBRA Assist Reprod 2020; 24:227-230. [PMID: 32072793 PMCID: PMC7169911 DOI: 10.5935/1518-0557.20190085] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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] [Indexed: 11/20/2022] Open
Abstract
Classical 3β-HSD deficiency due to mutations in the HSD3B2 gene is responsible for a rare form of congenital adrenal hyperplasia (CAH) and is identified by varying degrees of salt wasting. Preimplantation genetic diagnosis (PGD) was performed in a couple carrying mutation c.690 G>A in the HSD3B2 gene. Four polymorphic short tandem repeat markers closely linked to the HSD3B2 gene (D1S185, D1S453, D1S514, D1S540) for linkage analysis in conjunction with the direct mutation analysis were used in embryo genotyping. Two CODIS STRs (VWA and THO1) were also used to confirm embryo zygosity and rule out possible contaminations. Finally, SRY and AMYLOGENIN markers were used for embryo sex determination. PGD was performed by fluorescent multiplex seminested polymerase chain reaction and sequencing. Six embryos were tested and one male carrier embryo was transferred, resulting in the birth of a healthy boy.
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Affiliation(s)
- Fakhredin Reihani-Sabet
- Department of Genetics, Reproductive Biomedicine Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran
| | - Poopak Eftekhari-Yazdi
- Department of Embryology, Reproductive Biomedicine Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran
| | - Parnaz Borjian Boroujeni
- Department of Genetics, Reproductive Biomedicine Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran
| | - Javad Roodgar Saffari
- Department of Genetics, Reproductive Biomedicine Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran
| | - Navid Almadani
- Department of Genetics, Reproductive Biomedicine Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran
| | - Shirin Boloori
- Department of Genetics, Reproductive Biomedicine Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran
| | - Mohammad Reza Zamanian
- Department of Genetics, Reproductive Biomedicine Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran
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12
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Xu C, Jia W, Cheng X, Ying H, Chen J, Xu J, Guan Q, Zhou X, Zheng D, Li G, Zhao J. Genotype-phenotype correlation study and mutational and hormonal analysis in a Chinese cohort with 21-hydroxylase deficiency. Mol Genet Genomic Med 2019; 7:e671. [PMID: 30968594 PMCID: PMC6565591 DOI: 10.1002/mgg3.671] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [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: 09/11/2018] [Revised: 01/04/2019] [Accepted: 03/01/2019] [Indexed: 11/17/2022] Open
Abstract
Background Steroid 21‐hydroxylase deficiency (21OHD) is the most common enzymatic defect, but the genotype–phenotype associations have not been well established in Chinese patients. Here, a Chinese 21OHD cohort was enrolled to investigate the clinical, biochemical, and genetic characteristics of this disorder. Methods Mutation analysis of CYP21A2 gene, 21‐hydroxylase activity assays and in silico predictions of protein structure were performed. Genotype–phenotype associations were analyzed in both the cohort and 487 Chinese CAH patients ever reported. Results Among the total cohort (72 patients), 47 patients (65.3%) were diagnosed as salt‐wasting (SW) phenotype, 11 (15.3%) were simple virilizing (SV) type, and 14 (19.4%) were nonclassic (NC) type. The value of FSH and LH for prediction of the SW phenotype was up to 0.862 and 0.669, respectively. Overall, the detection rate of CYP21A2 mutation was 97.9%, which revealed 25 mutations and 36 genotypes. Four novel mutations (p.L199X, p.E321del, p.H393Q, and p.L459‐P464del) were detected and induced a significantly reduced 21‐hydroxylase activity. Generally, disease severity can be predicted with the genotypes. The most common genotypes in Chinese population were I2G/I2G (12.5%), I2G/Large lesion (12.1%), I173N/I2G (10.3%), and I173N/Large lesion (9.2%). The SW form of CAH is prominent in deletion or intronic splice mutations, namely I2G/I2G (18.6%), I2G/Large lesion (17.2%) and Large lesion/Large lesion (8.6%). Conclusion Four novel mutations were identified and a high consistency of genotype–phenotype association was found in SW CAH. Moreover, FSH and LH levels were proved to be a promising marker for predicting the severity of the disease.
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Affiliation(s)
- Chao Xu
- Department of Endocrinology and Metabolism, Shandong Provincial Hospital affiliated to Shandong University, Jinan, China.,Institute of Endocrinology, Shandong Academy of Clinical Medicine, Jinan, China.,Shandong Clinical Medical Center of Endocrinology and Metabolism, Jinan, China
| | - Wenyu Jia
- Department of Endocrinology and Metabolism, Shandong Provincial Hospital affiliated to Shandong University, Jinan, China.,Institute of Endocrinology, Shandong Academy of Clinical Medicine, Jinan, China.,Shandong Clinical Medical Center of Endocrinology and Metabolism, Jinan, China
| | - Xiangdeng Cheng
- Department of Pediatrics, Shandong Provincial Qianfoshan Hospital, Jinan, China
| | - Hui Ying
- Department of Endocrinology and Metabolism, Shandong Provincial Hospital affiliated to Shandong University, Jinan, China.,Institute of Endocrinology, Shandong Academy of Clinical Medicine, Jinan, China.,Shandong Clinical Medical Center of Endocrinology and Metabolism, Jinan, China
| | - Jing Chen
- Department of Child Health, Xiamen Maternal and Child Health Hospital affiliated to Xiamen University, Xiamen, China.,Department of Pediatrics, Shandong Provincial Hospital affiliated to Shandong University, Jinan, China
| | - Jin Xu
- Department of Endocrinology and Metabolism, Shandong Provincial Hospital affiliated to Shandong University, Jinan, China.,Institute of Endocrinology, Shandong Academy of Clinical Medicine, Jinan, China.,Shandong Clinical Medical Center of Endocrinology and Metabolism, Jinan, China
| | - Qingbo Guan
- Department of Endocrinology and Metabolism, Shandong Provincial Hospital affiliated to Shandong University, Jinan, China.,Institute of Endocrinology, Shandong Academy of Clinical Medicine, Jinan, China.,Shandong Clinical Medical Center of Endocrinology and Metabolism, Jinan, China
| | - Xinli Zhou
- Department of Endocrinology and Metabolism, Shandong Provincial Hospital affiliated to Shandong University, Jinan, China.,Institute of Endocrinology, Shandong Academy of Clinical Medicine, Jinan, China.,Shandong Clinical Medical Center of Endocrinology and Metabolism, Jinan, China
| | - Dongmei Zheng
- Department of Endocrinology and Metabolism, Shandong Provincial Hospital affiliated to Shandong University, Jinan, China.,Institute of Endocrinology, Shandong Academy of Clinical Medicine, Jinan, China.,Shandong Clinical Medical Center of Endocrinology and Metabolism, Jinan, China
| | - Guimei Li
- Department of Pediatrics, Shandong Provincial Hospital affiliated to Shandong University, Jinan, China
| | - Jiajun Zhao
- Department of Endocrinology and Metabolism, Shandong Provincial Hospital affiliated to Shandong University, Jinan, China.,Institute of Endocrinology, Shandong Academy of Clinical Medicine, Jinan, China.,Shandong Clinical Medical Center of Endocrinology and Metabolism, Jinan, China
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13
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Bañuelos Marco B, González R, Ludwikowski B, Lingnau A. Effectiveness of Prenatal Intervention on the Outcome of Diseases That Have a Postnatal Urological Impact. Front Pediatr 2019; 7:118. [PMID: 31001504 PMCID: PMC6454137 DOI: 10.3389/fped.2019.00118] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Accepted: 03/11/2019] [Indexed: 01/04/2023] Open
Abstract
We reviewed the literature addressing outcomes of fetal intervention of conditions that require post-natal urological management including lower urinary tract obstruction, hydrometrocolpos, congenital adrenal hyperplasia, and myelomeningocele. Despite several decades of fetal intervention for these conditions, benefits remain elusive in part because of the enormous difficulty of conducting prospective randomized studies. In this review, we reached the following conclusions: Prenatal intervention in lower urinary tract obstruction (LUTO) improves survival in the worst cases by improving pulmonary function and it may be advantageous for renal function, particularly in patients with adverse urine parameters.Prenatal treatment of female fetuses at risk of having congenital adrenal hyperplasia (CAH) reduces virilization. Non-invasive fetal DNA analysis allows earlier diagnosis, reducing the risk of treating with dexamethasone males and non-affected fetuses.Fetal treatment of myelomeningocele (MMC) is gaining momentum. Prospective studies including standardized urologic evaluation will determine if the encouraging results reported by some hold on the long term follow-up.
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Affiliation(s)
| | - Ricardo González
- Department of Urology, Charité Medical University of Berlin, Berlin, Germany.,Pediatric Surgery and Urology, Kinder- und Jugendkrankenhaus AUF DER BULT, Hanover, Germany
| | - Barbara Ludwikowski
- Pediatric Surgery and Urology, Kinder- und Jugendkrankenhaus AUF DER BULT, Hanover, Germany
| | - Anja Lingnau
- Department of Urology, Charité Medical University of Berlin, Berlin, Germany
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14
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Chatziaggelou A, Sakkas EG, Votino R, Papagianni M, Mastorakos G. Assisted Reproduction in Congenital Adrenal Hyperplasia. Front Endocrinol (Lausanne) 2019; 10:723. [PMID: 31708872 PMCID: PMC6819309 DOI: 10.3389/fendo.2019.00723] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Accepted: 10/07/2019] [Indexed: 12/13/2022] Open
Abstract
Congenital Adrenal Hyperplasia (CAH) is a group of autosomal recessive disorders characterized by defects of adrenal steroidogenesis due to mutations in one of the following enzymes: 21-hydroxylase (21OH), 11β-hydroxylase (11βOH), 17α-hydroxylase (17OH; also known as 17, 20-lyase), 3β hydroxysteroid dehydrogenase type 2 (3βHSD2), steroidogenic acute regulatory protein (StAR), P450 cholesterol side-chain cleavage (P450scc), and P450 oxidoreductase (POR). More than 95% of congenital adrenal hyperplasia cases are due to mutations in CYP21A2, the gene encoding the adrenal steroid 21-hydroxylase enzyme (P450c21). This work focuses on this type of CAH given that it is the most frequent one. This disease is characterized by impaired cortisol and aldosterone production as well as androgen excess. A variant of the CAH is the non-classic type of CAH (NCCAH), usually asymptomatic before the 5th year of age, diagnosed during puberty especially in patients visiting a fertility clinic. NCCAH is characterized mainly by anovulatory cycles and/or high androgen concentrations. Both types of CAH are associated with infertility. Given that the incidence of NCCAH is greater than that of CAH, patients suffering from NCCAH are more often diagnosed for the first time in a fertility clinic. Thus, screening for NCCAH should always be considered. The causes of infertility in CAH patients are multi-factorial including virilization of external genitalia, altered psychosocial development, and hormonal disorders. The main challenges encountered in assisted reproduction are the androgen excess-associated anovulatory cycles as well as the increased circulating progesterone concentrations during the follicular phase which impact endometrial receptivity, tubal motility, and cervical thickness. Administration of sufficient substitution dose of glucocorticoids usually resolves these problems and leads not only to successful assisted reproduction treatment but also to spontaneous pregnancy. Patients with CAH should be followed by a multidisciplinary team including gynecologist, endocrinologist, and pediatrician.
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Affiliation(s)
| | - Evangelos G. Sakkas
- Unit of Endocrinology, Diabetes Mellitus and Metabolism, 2nd Department of Obstetrics and Gynecology, Medical School, Aretaieion Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Raffaella Votino
- Unit of Endocrinology, Diabetes Mellitus and Metabolism, 2nd Department of Obstetrics and Gynecology, Medical School, Aretaieion Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Maria Papagianni
- Pediatric Endocrinology Unit, 3rd Department of Pediatrics, Medical School, Hippokrateion General Hospital of Thessaloniki, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - George Mastorakos
- Unit of Endocrinology, Diabetes Mellitus and Metabolism, 2nd Department of Obstetrics and Gynecology, Medical School, Aretaieion Hospital, National and Kapodistrian University of Athens, Athens, Greece
- *Correspondence: George Mastorakos
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15
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González R, Ludwikowski BM. Is It Beneficial to Patients to Include Congenital Adrenal Hyperplasia (CAH) Among the Disorders of Sex Development (DSD)? Front Pediatr 2018; 6:344. [PMID: 30483487 PMCID: PMC6240692 DOI: 10.3389/fped.2018.00344] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2018] [Accepted: 10/23/2018] [Indexed: 12/31/2022] Open
Affiliation(s)
- Ricardo González
- Pediatric Surgery and Urology, Kinder-und Jugendkrankenhaus AUF DER BULT, Hanover, Germany
| | - Barbara M Ludwikowski
- Pediatric Surgery and Urology, Kinder-und Jugendkrankenhaus AUF DER BULT, Hanover, Germany
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16
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Meng X, Yu Y. NONCLASSICAL 21-HYDROXYLASE DEFICIENCY PRESENTED AS ADDISON'S DISEASE AND BILATERAL ADRENAL INCIDENTALOMAS. Acta Endocrinol (Buchar) 2017; 13:232-236. [PMID: 31149180 DOI: 10.4183/aeb.2017.232] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Background 21-hydroxylase deficiency (21 OHD) is the most common form of congenital adrenal hyperplasia (CAH) and it has been widely described in the literature. Adrenocortical incidentalomas are unfrequently the presenting manifestations of CAH, especially in nonclassical form of 21 OHD (NC 21 OHD). Myelolipoma has previously been reported more frequently than other adrenal adenomas associated with CAH. Case We report a 40-year old male case of NC 21 OHD with hypoadrenocorticism after unilateral adrenalectomy of the right side because of a large solid incidentaloma (5×4×4cm3) at the age of 31. This patient began to suffer from obvious symptoms of adrenal insufficiency after 9 years from the surgery. He was reviewed and a very low-density adrenal mass (4.1×3.9cm) was found on computed tomography of the abdomen. After he was admitted to our hospital, this patient was confirmed with NC 21 OHD and presented low level cortisol, striking elevated ACTH, aldosterone insufficiency, increased 17-hydroxyprogesterone, progesterone, decreasing androgens and azoospermatism. Conclusion Patients with 21 OHD could be on risk not only for adrenal hyperplasia, but also to develop adrenal adenomas, particularly if the disease was poorly controlled.
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Affiliation(s)
- X Meng
- West China Hospital, Sichuan University, Sichuan, China
| | - Y Yu
- West China Hospital, Sichuan University, Sichuan, China
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17
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Inada H, Imamura T, Nakajima R, Yamano T. Poor response to substitution therapy with cortisone acetate in patients with congenital adrenal hyperplasia. Clin Pediatr Endocrinol 2004; 13:11-5. [PMID: 24790292 PMCID: PMC4004908 DOI: 10.1297/cpe.13.11] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2003] [Accepted: 12/11/2003] [Indexed: 01/06/2023] Open
Abstract
Although cortisone acetate is approved worldwide as corticosteroid substitution
therapy in congenital adrenal hyperplasia (21-hydroxylase deficiency), its effectiveness
is uncertain since its biologic activity depends on activation by
11β-hydroxysteroid dehydrogenase (11β-HSD). We sought to
compare the effect of cortisone acetate with that of hydrocortisone. In 10 patients with
congenital adrenal hyperplasia, cortisone acetate was replaced with hydrocortisone in
substitution therapy. During this change, blood concentrations of 17-hydroxy-progesterone,
adrenocorticotropin (ACTH), and requirements for each drug were monitored. Concentrations
of 17-hydroxyprogesterone decreased (mean 10.1 vs. 48.6 ng/ml), as did those of ACTH.
Cortisone acetate dose requirements averaged 33.9 mg/m2, while hydrocortisone
dose requirements averaged only 20.3 mg/m2. In one of the patients resistant to
cortisone acetate therapy, DNA sequences in the coding regions and promoter of the
11β-HSD gene were analyzed, detecting no genetic abnormalities.
Cortisone acetate is inferior to hydrocortisone as substitution therapy in patients with
congenital adrenal hyperplasia.
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Affiliation(s)
- Hiroshi Inada
- Department of Pediatrics, Osaka City University Graduate School of Medicine, Japan
| | - Takuji Imamura
- Department of Pediatrics, Osaka City University Graduate School of Medicine, Japan
| | - Ryoichi Nakajima
- Department of Pediatrics, Osaka City University Graduate School of Medicine, Japan
| | - Tsunekazu Yamano
- Department of Pediatrics, Osaka City University Graduate School of Medicine, Japan
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