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Genotype, Mortality, Morbidity, and Outcomes of 3β-Hydroxysteroid Dehydrogenase Deficiency in Algeria

BACKGROUND: 3β-hydroxysteroid dehydrogenase 2 (3βHSD2) deficiency is a rare form of congenital adrenal hyperplasia (CAH), with fewer than 200 cases reported in the world literature and few data on outcomes. PATIENTS AND METHODS: We report a mixed longitudinal and cross-sectional study from a single...

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Autores principales: Ladjouze, Asmahane, Donaldson, Malcolm, Plotton, Ingrid, Djenane, Nacima, Mohammedi, Kahina, Tardy-Guidollet, Véronique, Mallet, Delphine, Boulesnane, Kamélia, Bouzerar, Zair, Morel, Yves, Roucher-Boulez, Florence
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Frontiers Media S.A. 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9229600/
https://www.ncbi.nlm.nih.gov/pubmed/35757411
http://dx.doi.org/10.3389/fendo.2022.867073
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author Ladjouze, Asmahane
Donaldson, Malcolm
Plotton, Ingrid
Djenane, Nacima
Mohammedi, Kahina
Tardy-Guidollet, Véronique
Mallet, Delphine
Boulesnane, Kamélia
Bouzerar, Zair
Morel, Yves
Roucher-Boulez, Florence
author_facet Ladjouze, Asmahane
Donaldson, Malcolm
Plotton, Ingrid
Djenane, Nacima
Mohammedi, Kahina
Tardy-Guidollet, Véronique
Mallet, Delphine
Boulesnane, Kamélia
Bouzerar, Zair
Morel, Yves
Roucher-Boulez, Florence
author_sort Ladjouze, Asmahane
collection PubMed
description BACKGROUND: 3β-hydroxysteroid dehydrogenase 2 (3βHSD2) deficiency is a rare form of congenital adrenal hyperplasia (CAH), with fewer than 200 cases reported in the world literature and few data on outcomes. PATIENTS AND METHODS: We report a mixed longitudinal and cross-sectional study from a single Algerian center between 2007 and 2021. Virilization and under-masculinization were assessed using Prader staging and the external masculinization score (EMS), pubertal development staged according to the system of Tanner. Adrenal steroids were measured using mass spectrophotometry (LC-MS/MS). A genetic analysis of HSD3B2 was performed using Sanger sequencing. RESULTS: A 3βHSD2 defect was confirmed in 6 males and 8 females from 10 families (8 consanguineous), with p.Pro222Gln mutation in all but two siblings with a novel deletion: c.453_464del or p.(Thr152_Pro155del). Probable 3βHSD2 deficiency was diagnosed retrospectively in a further 6 siblings who died, and in two patients from two other centers. In the genetically confirmed patients, the median (range) age at presentation was 20 (0–390) days, with salt-wasting (n = 14) and genital anomaly (n = 10). The Prader stage for female patients was 2 (1–2) with no posterior fusion of the labia. The EMS for males was 6 (3–9). Median (range) values at diagnosis for 17-hydroxyprogesterone (17-OHP), dehydroepiandrosterone sulfate (DHEA-S), and 17-hydroxypregnenolone (17OHPreg) were elevated: 73.7 (0.37–164.3) nmol/L; 501.2(9.4–5441.3) nmol/L, and 139.7 (10.9–1500) nmol/l (NB >90 nmol/L diagnostic of 3βHSD2 defect). Premature pubarche was observed in four patients (3F:1M). Six patients (5F:1M) entered puberty spontaneously, aged 11 (5–13) years in 5 girls and 11.5 years in one boy. Testicular adrenal rest tumors were found in three boys. Four girls reached menarche at 14.3 (11–14.5) years, with three developing adrenal masses (surgically excised in two) and polycystic ovary syndrome (PCOS), with radiological evidence of ovarian adrenal rest tumor in one. The median IQ was 90 (43–105), >100 in only two patients and <70 in three. CONCLUSIONS: The prevalence of 3βHSD2 deficiency in Algeria appears high, with p.Pro222Gln being the most frequent mutation. Mortality is also high, with significant morbidity from adrenal tumors and PCOS in adolescence and an increased risk of learning disability. The finding of adrenal tumors in older patients with 3βHSD2 indicates under-replacement, requiring effective hydrocortisone and fludrocortisone treatment rather than surgical removal.
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spelling pubmed-92296002022-06-25 Genotype, Mortality, Morbidity, and Outcomes of 3β-Hydroxysteroid Dehydrogenase Deficiency in Algeria Ladjouze, Asmahane Donaldson, Malcolm Plotton, Ingrid Djenane, Nacima Mohammedi, Kahina Tardy-Guidollet, Véronique Mallet, Delphine Boulesnane, Kamélia Bouzerar, Zair Morel, Yves Roucher-Boulez, Florence Front Endocrinol (Lausanne) Endocrinology BACKGROUND: 3β-hydroxysteroid dehydrogenase 2 (3βHSD2) deficiency is a rare form of congenital adrenal hyperplasia (CAH), with fewer than 200 cases reported in the world literature and few data on outcomes. PATIENTS AND METHODS: We report a mixed longitudinal and cross-sectional study from a single Algerian center between 2007 and 2021. Virilization and under-masculinization were assessed using Prader staging and the external masculinization score (EMS), pubertal development staged according to the system of Tanner. Adrenal steroids were measured using mass spectrophotometry (LC-MS/MS). A genetic analysis of HSD3B2 was performed using Sanger sequencing. RESULTS: A 3βHSD2 defect was confirmed in 6 males and 8 females from 10 families (8 consanguineous), with p.Pro222Gln mutation in all but two siblings with a novel deletion: c.453_464del or p.(Thr152_Pro155del). Probable 3βHSD2 deficiency was diagnosed retrospectively in a further 6 siblings who died, and in two patients from two other centers. In the genetically confirmed patients, the median (range) age at presentation was 20 (0–390) days, with salt-wasting (n = 14) and genital anomaly (n = 10). The Prader stage for female patients was 2 (1–2) with no posterior fusion of the labia. The EMS for males was 6 (3–9). Median (range) values at diagnosis for 17-hydroxyprogesterone (17-OHP), dehydroepiandrosterone sulfate (DHEA-S), and 17-hydroxypregnenolone (17OHPreg) were elevated: 73.7 (0.37–164.3) nmol/L; 501.2(9.4–5441.3) nmol/L, and 139.7 (10.9–1500) nmol/l (NB >90 nmol/L diagnostic of 3βHSD2 defect). Premature pubarche was observed in four patients (3F:1M). Six patients (5F:1M) entered puberty spontaneously, aged 11 (5–13) years in 5 girls and 11.5 years in one boy. Testicular adrenal rest tumors were found in three boys. Four girls reached menarche at 14.3 (11–14.5) years, with three developing adrenal masses (surgically excised in two) and polycystic ovary syndrome (PCOS), with radiological evidence of ovarian adrenal rest tumor in one. The median IQ was 90 (43–105), >100 in only two patients and <70 in three. CONCLUSIONS: The prevalence of 3βHSD2 deficiency in Algeria appears high, with p.Pro222Gln being the most frequent mutation. Mortality is also high, with significant morbidity from adrenal tumors and PCOS in adolescence and an increased risk of learning disability. The finding of adrenal tumors in older patients with 3βHSD2 indicates under-replacement, requiring effective hydrocortisone and fludrocortisone treatment rather than surgical removal. Frontiers Media S.A. 2022-06-10 /pmc/articles/PMC9229600/ /pubmed/35757411 http://dx.doi.org/10.3389/fendo.2022.867073 Text en Copyright © 2022 Ladjouze, Donaldson, Plotton, Djenane, Mohammedi, Tardy-Guidollet, Mallet, Boulesnane, Bouzerar, Morel and Roucher-Boulez https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
spellingShingle Endocrinology
Ladjouze, Asmahane
Donaldson, Malcolm
Plotton, Ingrid
Djenane, Nacima
Mohammedi, Kahina
Tardy-Guidollet, Véronique
Mallet, Delphine
Boulesnane, Kamélia
Bouzerar, Zair
Morel, Yves
Roucher-Boulez, Florence
Genotype, Mortality, Morbidity, and Outcomes of 3β-Hydroxysteroid Dehydrogenase Deficiency in Algeria
title Genotype, Mortality, Morbidity, and Outcomes of 3β-Hydroxysteroid Dehydrogenase Deficiency in Algeria
title_full Genotype, Mortality, Morbidity, and Outcomes of 3β-Hydroxysteroid Dehydrogenase Deficiency in Algeria
title_fullStr Genotype, Mortality, Morbidity, and Outcomes of 3β-Hydroxysteroid Dehydrogenase Deficiency in Algeria
title_full_unstemmed Genotype, Mortality, Morbidity, and Outcomes of 3β-Hydroxysteroid Dehydrogenase Deficiency in Algeria
title_short Genotype, Mortality, Morbidity, and Outcomes of 3β-Hydroxysteroid Dehydrogenase Deficiency in Algeria
title_sort genotype, mortality, morbidity, and outcomes of 3β-hydroxysteroid dehydrogenase deficiency in algeria
topic Endocrinology
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9229600/
https://www.ncbi.nlm.nih.gov/pubmed/35757411
http://dx.doi.org/10.3389/fendo.2022.867073
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