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The condition of 21-hydroxylase deficiency is screened by measuring serum levels of 17α-hydroxyprogesterone (17-OHP) in the morning and between day 3 and 5 of the menstrual cycle (for females) to reduce the possibility of false positive results. [11] 17-OHP is used as a marker of the 21-hydroxylase enzyme activity since the 1980s. [51]
The 21-hydroxylase deficiency may be caused by macrodeletions of about 30 Kb, which includes not only most of the 5′ region of the CYP21A2 gene, but also all of the C4B gene and 3′ regions of the CYP21A1P pseudogene. Duplications of CYP21A1P pseudogene and C4B gene are often associated with nonclassic 21-hydroxylase deficiency. [33]
Non-classical congenital adrenal hyperplasia caused by 21-hydroxylase deficiency (NCCAH) is a milder and late-onset congenital adrenal hyperplasia. Its prevalence rate in different ethnic groups varies from 1 in 1000 to 1 in 50 . [ 58 ]
21-deoxycortisol is a marker of congenital adrenal hyperplasia due to 21-hydroxylase deficiency, [2] [1] [3] even in mild (non-classic) cases. [4] [5] It can be also used for newborn screening. [6] The deficiency of the 21-hydroxylase enzyme leads to excess of 17α-hydroxyprogesterone, [7] [8] a 21-carbon (C 21) steroid.
Measurement of 17α-OHP by LC-MS/MS improves newborn screening for congenital adrenal hyperplasia due to 21-hydroxylase deficiency, because 17α-OHP steroid precursors and their sulphated conjugates which are present in the first two days after birth and longer in pre-term neonates, cross-react in immunoassays with 17α-OHP, giving falsely high ...
17α-hydroxylase deficiency; 17,20 lyase deficiency; 17β-hydroxysteroid dehydrogenase deficiency; 5α-reductase deficiency; Androgen excess in 46,XX individuals: 21-hydroxylase deficiency; 3β-hydroxysteroid dehydrogenase 2 deficiency; Cytochrome P450 oxidoreductase deficiency (disorder in mother causes 46,XX fetal virilization) 11β ...
It has been known since 1987 that increased levels of 11β-OHP occur in 21-hydroxylase deficiency. [6] [7] A study in 2017 has shown that in subjects with 21-hydroxylase deficiency, serum 11β-OHP concentrations range from 0.012 to 3.37 ng/mL, while in control group it was below detection limit of 0.012 ng/mL.
Congenital adrenal hyperplasia due to 17α-hydroxylase deficiency is an uncommon form of congenital adrenal hyperplasia (CAH) resulting from a mutation in the gene CYP17A1, which produces the enzyme 17α-hydroxylase. [1] [2] It causes decreased synthesis of cortisol and sex hormones, with resulting increase in mineralocorticoid production.