Department of Endocrinology and Metabolic, The First Hospital of Lanzhou University, Lanzhou, Gansu, P.R.China.
Department of General Family Medicine, The First Hospital of Lanzhou University, Lanzhou, Gansu, P.R.China.
Gynecol Endocrinol. 2023 Aug 18;39(1):2250001. doi: 10.1080/09513590.2023.2250001.
Congenital adrenal hyperplasia (CAH) is an autosomal recessive disorder with a related enzyme deficiency involved in the adrenal corticosteroid synthesis pathway due to genetic mutations. 17α-hydroxylase deficiency(17α-OHD) is a rare form of CAH. Herein, we reported clinical data on diagnosis and treatment regimens for a 17α-hydroxylase-deficient patient. A 24-year-old female patient was admitted to the hospital with limb numbness for 7 days and sudden limb weakness. Full laboratory and radio-imaging investigations showed hypokalemia and abdominal occupation. Abnormal rhythm of cortisol(Cor) and adrenocorticotrophic hormone (ACTH)was observed. The diagnosis was confirmed by molecular mutation detection, which showed a homozygous mutation of in the 17-hydroxylase/17,20-lyase deficiency (17OHD) lease-related from both biological parents. The patient was treated with prednisone acetate and estradiol valerate. After one year of treatment with predisoone acetate and estradiol valerate, the patient had normal menstruation, increased blood potassium, estradiol and 24h-UFC, and decreased ACTH level. There is no significant change in large adrenal hyperplasia lesions although sexual characteristics and menstrual cycles have recovered. Through this case and literature review, it can be concluded that CAH with 17α-OHD can be diagnosed according to the genetic detection.
先天性肾上腺皮质增生症(CAH)是一种常染色体隐性遗传病,由于基因突变导致肾上腺皮质类固醇合成途径中的相关酶缺乏。17α-羟化酶缺乏症(17α-OHD)是 CAH 的一种罕见形式。本文报告了 1 例 17α-羟化酶缺陷患者的诊断和治疗方案的临床数据。1 例 24 岁女性患者因四肢麻木 7 天伴四肢无力入院。全实验室和影像学检查显示低钾血症和腹部占位。皮质醇(Cor)和促肾上腺皮质激素(ACTH)节律异常。通过分子突变检测确诊,从父母双方均检测到 17-羟化酶/17,20-裂合酶缺乏症(17OHD)相关的 17α-羟化酶基因的纯合突变。患者接受醋酸泼尼松龙和戊酸雌二醇治疗。醋酸泼尼松龙和戊酸雌二醇治疗 1 年后,患者月经正常,血钾、雌二醇和 24h-UFC 增加,ACTH 水平降低。虽然性特征和月经周期已经恢复,但大肾上腺增生病变没有明显变化。通过本例和文献复习可以得出结论,CAH 伴 17α-OHD 可根据基因检测进行诊断。