Primary Adrenal Insufficiency, Complete Sex Reversal, and Unique Clinical Phenotype in a Patient with Severe CYP11A1 (P450scc) Deficiency-Case Report and Literature Overview.

IF 2 4区 医学 Q2 PEDIATRICS
Zuzanna Nowak, Ewelina Preizner-Rzucidło, Jakub Gawlik, Jerzy B Starzyk, Dominika Januś
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引用次数: 0

Abstract

Background: Congenital adrenal hyperplasia (CAH) is a group of genetic disorders that lead to the dysfunction of the steroidogenesis pathway, resulting in steroid hormone deficiency of varied intensity. The cholesterol side-chain cleavage enzyme (P450scc), coded by the CYP11A1 gene, is vital to the first step in the biosynthesis of steroid hormones, which is the conversion of cholesterol to pregnenolone. Therefore, its deficiency causes a general steroid hormone shortage.

Objective: We report a case of CAH caused by P450scc deficiency with complete 46, XY sex reversal, characteristic facial features (narrow middle section of the face, small ears with thick helix, fleshy upturned lobules), and dysmorphic macrocephaly along with shortened upper and lower extremities.

Results: Our patient carries a compound heterozygotic pathogenic variant of the CYP11A1 gene, with two frameshift pathogenic variants NM_000781.3(CYP11A1):c.358del (p.Arg120Aspfs*18) in exon 2 and NM_000781.3(CYP11A1):c.835del (p.Ile279Tyrfs*10) in exon 5. To date, only around 50 cases with CYP11A1 pathogenic variants have been reported worldwide. We believe this is the first described case of a newborn with severe, classic P450scc deficiency in Poland.

Conclusions: CYP11A1 (P450scc) deficiency is a rare and complex disorder that leads to primary adrenal insufficiency and may present with 46, XY disorders of sex development (DSD), phenotypic variations, and associated endocrinological abnormalities. This case, along with others cited, highlights the diverse presentations of DSD in individuals with pathogenic CYP11A1 variants. Optimal management necessitates a multidisciplinary approach by a specialized DSD team. Gonadectomy is a key consideration to decrease the teratogenic risk associated with intra-abdominal gonadal tissue.

一名严重 CYP11A1 (P450scc) 缺陷患者的原发性肾上腺功能不全、完全性逆转和独特临床表型--病例报告和文献综述。
背景:先天性肾上腺皮质增生症(CAH)是一组遗传性疾病,可导致类固醇生成途径功能障碍,造成不同程度的类固醇激素缺乏。由 CYP11A1 基因编码的胆固醇侧链裂解酶(P450scc)对类固醇激素生物合成的第一步--胆固醇转化为孕烯醇酮--至关重要。因此,缺乏该基因会导致类固醇激素的普遍缺乏:我们报告了一例由 P450scc 缺乏引起的 CAH 病例,该病例伴有完全的 46 XY 性别反转、特征性面部特征(面部中段狭窄、小耳朵带厚螺旋、肉质上翘小叶)、畸形性巨头畸形以及上下肢短小:结果:我们的患者携带CYP11A1基因的复合杂合致病变体,其中第2外显子有两个移帧致病变体NM_000781.3(CYP11A1):c.358del(p.Arg120Aspfs*18),第5外显子有两个移帧致病变体NM_000781.3(CYP11A1):c.835del(p.Ile279Tyrfs*10)。迄今为止,全世界仅报道了约 50 例 CYP11A1 致病变体病例。我们认为,这是波兰首例描述的新生儿严重典型 P450scc 缺乏症病例:结论:CYP11A1(P450scc)缺乏症是一种罕见的复杂疾病,可导致原发性肾上腺功能不全,并可能伴有46、XY性别发育障碍(DSD)、表型变异和相关的内分泌异常。本病例和其他病例都突出显示了具有致病性 CYP11A1 变体的个体在 DSD 中的不同表现。最佳治疗方法需要由专业的 DSD 团队采取多学科方法。性腺切除术是降低腹腔内性腺组织致畸风险的关键考虑因素。
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来源期刊
Children-Basel
Children-Basel PEDIATRICS-
CiteScore
2.70
自引率
16.70%
发文量
1735
审稿时长
6 weeks
期刊介绍: Children is an international, open access journal dedicated to a streamlined, yet scientifically rigorous, dissemination of peer-reviewed science related to childhood health and disease in developed and developing countries. The publication focuses on sharing clinical, epidemiological and translational science relevant to children’s health. Moreover, the primary goals of the publication are to highlight under‑represented pediatric disciplines, to emphasize interdisciplinary research and to disseminate advances in knowledge in global child health. In addition to original research, the journal publishes expert editorials and commentaries, clinical case reports, and insightful communications reflecting the latest developments in pediatric medicine. By publishing meritorious articles as soon as the editorial review process is completed, rather than at predefined intervals, Children also permits rapid open access sharing of new information, allowing us to reach the broadest audience in the most expedient fashion.
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