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Phadte A, Dhole C, Hegishte S, Sarathi V, Lila A, Gada JV, Memon SS, Arya S, Karlekar M, Patil V, Varthakavi PK, Shah N, Bhagwat NM, Bandgar T. Steroidogenic acute regulatory protein (STAR) deficiency: Our experience and systematic review for phenotype-genotype correlation. Clin Endocrinol (Oxf) 2024; 100:431-440. [PMID: 38368602 DOI: 10.1111/cen.15032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Revised: 01/18/2024] [Accepted: 02/04/2024] [Indexed: 02/20/2024]
Abstract
OBJECTIVE Lipoid congenital adrenal hyperplasia (LCAH) is caused by mutations in STAR. A systematic review of phenotype-genotype correlation and data on testicular histology in LCAH patients is unavailable. We aim to describe our experience and provide phenotype-genotype correlation. DESIGN, PATIENTS AND MEASUREMENTS: Retrospective review of three genetically proven LCAH patients from our centre and per-patient data analysis from a systematic review of 292 probands. The phenotypic subgroups of 46,XY were Group A (typical female genitalia), Group B (atypical genitalia) and Group C (typical male genitalia). RESULTS We report three new LCAH probands from India, all diagnosed post-infancy with preserved gonadal function and one novel variant. The systematic review reports 46,XY to 46,XX LCAH ratio of 1.1 (155:140). Patients with 46,XY LCAH in Group A were diagnosed in infancy (116/117) and had higher mineralocorticoid involvement than Group C (96.4% vs. 75%, p = 0.035), whereas Group C had preserved gonadal function. Hyperplastic adrenals are noted in ~60% of LCAH diagnosed with primary adrenal insufficiency in infancy. There was no report of gonadal germ cell cancer and rare reports of germ cell neoplasia in situ in adolescents, especially with intraabdominal gonads. Two-thirds of LCAH probands were East-Asian and 11/16 regional recurrent variants were from East Asia. There was minimal overlap between variants in Groups A (n = 55), B (n = 9) and C (n = 8). All nonsense and frameshift and most of the splice-site variants and deletion/insertions were present in Group A. CONCLUSIONS We report three new cases of LCAH from India. We propose a phenotype-derived genotypic classification of reported STAR variants in 46,XY LCAH.
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Affiliation(s)
- Aditya Phadte
- Department of Endocrinology, Seth G S Medical College and KEM Hospital, Mumbai, India
| | - Charushila Dhole
- Department of Endocrinology, Topiwala National Medical College and BYL Nair Charitable Hospital, Mumbai, India
| | - Samiksha Hegishte
- Department of Endocrinology, Seth G S Medical College and KEM Hospital, Mumbai, India
| | - Vijaya Sarathi
- Department of Endocrinology, Vydehi Institute of Medical Sciences and Research Centre, Bangalore, India
| | - Anurag Lila
- Department of Endocrinology, Seth G S Medical College and KEM Hospital, Mumbai, India
| | - Jugal V Gada
- Department of Endocrinology, Topiwala National Medical College and BYL Nair Charitable Hospital, Mumbai, India
| | - Saba Samad Memon
- Department of Endocrinology, Seth G S Medical College and KEM Hospital, Mumbai, India
| | - Sneha Arya
- Department of Endocrinology, Seth G S Medical College and KEM Hospital, Mumbai, India
| | - Manjiri Karlekar
- Department of Endocrinology, Seth G S Medical College and KEM Hospital, Mumbai, India
| | - Virendra Patil
- Department of Endocrinology, Seth G S Medical College and KEM Hospital, Mumbai, India
| | - Premlata K Varthakavi
- Department of Endocrinology, Topiwala National Medical College and BYL Nair Charitable Hospital, Mumbai, India
| | - Nalini Shah
- Department of Endocrinology, Seth G S Medical College and KEM Hospital, Mumbai, India
| | - Nikhil M Bhagwat
- Department of Endocrinology, Topiwala National Medical College and BYL Nair Charitable Hospital, Mumbai, India
| | - Tushar Bandgar
- Department of Endocrinology, Seth G S Medical College and KEM Hospital, Mumbai, India
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Lu W, Zhang T, Zhang L, Wang X, Lv S, Wang J, Ye L, Xiao Y, Dong Z, Wang W, Sun S, Li C, Hu R, Ning G, Ma X. Clinical characteristics of a male child with non-classic lipoid congenital adrenal hyperplasia and literature review. Front Endocrinol (Lausanne) 2022; 13:947762. [PMID: 36407315 PMCID: PMC9666400 DOI: 10.3389/fendo.2022.947762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Accepted: 10/12/2022] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Lipoid congenital adrenal hyperplasia (LCAH) is a rare and severe disorder that is caused by mutations in the steroidogenic acute regulatory protein (StAR). Non-classic LCAH is defined as late-onset glucocorticoid deficiency and even complete male external genitalia in 46,XY individuals. However, to date, few cases of non-classic LCAH have been reported. METHODS It was attempted to describe the clinical characteristics of a male child with complete male external genitalia in terms of age of onset, adrenal function, and biochemical indicators. Previously reported cases were also reviewed to investigate the relationship of age of onset with enzymatic activity in non-classic LCAH. RESULTS The patient with complete male external genitalia was diagnosed with non-classic LCAH, in which the reason for his referral to a local hospital at the of age 1.25 years was progressive skin hyperpigmentation, and plasma adrenocorticotropic hormone (ACTH) level was elevated to higher than 1,250 pg/ml. The compound heterozygous mutations c.772C>T/c.562C>T in STAR gene were identified via genetic testing. The literature review resulted in identification of 47 patients with non-classic LCAH from 36 families. The mutational analysis showed that c.562C>T mutation was prevalent in patients with non-classic LCAH, accounting for 37.2% of the total mutant alleles, which could reflect the founder effect on the non-classic LCAH population. In total, 28 46,XY patients were reported, including 22 (78.5%) cases with complete male external genitalia and six (21.5%) cases with different degrees of hypospadias. CONCLUSION The clinical phenotypes of non-classic LCAH are highly variable. Routine physical examination, laboratory measurement, genetic testing, and, importantly, enzymatic activity assay may facilitate the early diagnosis of non-classic LCAH. The age of primary adrenal insufficiency (PAI) onset may not be a diagnostic basis for non-classic LCAH, and enzymatic activity assay determination may be more effective.
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Affiliation(s)
- Wenli Lu
- Department of Pediatrics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Tingting Zhang
- Department of Pediatric Genetic and Metabolic Endocrinology, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Lidan Zhang
- Department of Pediatrics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xueqing Wang
- Department of Pediatrics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Sheng Lv
- Department of Pediatrics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Junqi Wang
- Department of Pediatrics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Lei Ye
- Department of Endocrine and Metabolism, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yuan Xiao
- Department of Pediatrics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zhiya Dong
- Department of Pediatrics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Wei Wang
- Department of Pediatrics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Shuoyue Sun
- Department of Endocrine and Metabolism, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Chuanyin Li
- Cancer Center, Shanghai Tenth People’s Hospital, School of Medicine, Tongji University, Shanghai, China
- *Correspondence: Chuanyin Li, ; Ronggui Hu, ; Guang Ning, ; Xiaoyu Ma,
| | - Ronggui Hu
- Cancer Center, Shanghai Tenth People’s Hospital, School of Medicine, Tongji University, Shanghai, China
- *Correspondence: Chuanyin Li, ; Ronggui Hu, ; Guang Ning, ; Xiaoyu Ma,
| | - Guang Ning
- Department of Endocrine and Metabolism, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- *Correspondence: Chuanyin Li, ; Ronggui Hu, ; Guang Ning, ; Xiaoyu Ma,
| | - Xiaoyu Ma
- Department of Pediatrics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- *Correspondence: Chuanyin Li, ; Ronggui Hu, ; Guang Ning, ; Xiaoyu Ma,
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Li L, Wu Y, Zhao C, Miao Y, Cai J, Song L, Wei J, Chakraborty T, Wu L, Wang D, Zhou L. The role of StAR2 gene in testicular differentiation and spermatogenesis in Nile tilapia (Oreochromis niloticus). J Steroid Biochem Mol Biol 2021; 214:105974. [PMID: 34425195 DOI: 10.1016/j.jsbmb.2021.105974] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 07/30/2021] [Accepted: 08/04/2021] [Indexed: 11/21/2022]
Abstract
Sex steroids play critical roles in sex differentiation and gonadal development in teleosts. Steroidogenic acute regulatory protein (StAR), transporting cholesterol (the substrate for steroidogenesis) from the outer mitochondrial membrane to the inner membrane, is the first rate-limiting factor of steroidogenesis. Interestingly, two StAR genes (named as StAR1 and StAR2) have been isolated from non-mammalian vertebrates. To characterize the functions of the novel StAR2 gene in the gonadal differentiation and fertility, we generated a StAR2 homozygous mutant line in Nile tilapia (Oreochromis niloticus). StAR2 gene knockout in male tilapia impeded meiotic initiation, associate with the down-regulation of meiosis related gene expressions of vasa, sycp3 and dazl at 90 days after hatching (dah). Meanwhile, cyp11b2 expression and serum 11-KT production significantly declined in StAR2-/- XY fish at 90 dah. From 120-300 dah, spermatogenesis gradually recovered, and so did the expressions of vasa, sycp3 and dazl in StAR2-/- XY fish testes. However, seminiferous lobules arranged disorderly in StAR2-/- XY fish testes at 300 dah. The number of Leydig cells and expressions of downstream steroidogenesis enzymes including cyp11a1, 3β-HSD-I, 3β-HSD-II, cyp17a1 and cyp17a2 decreased in StAR2-/- XY fish testes at 300 dah. Serum testosterone and 11-KT levels were significantly lower in StAR2-/- XY fish than that of their control counterparts. Furthermore, significantly elevated ar, fsh and lh expressions in StAR2-deficient XY fish testes and pituitaries were found when compared with the control XY fish. Testes degeneration and spermatogenic cell apoptosis were observed, while no sperm were squeezed out in StAR2-/- XY fish testes at 540 dah. Taken together, our results suggest that StAR2 has a role in testicular development, spermatogenesis and spermiation by regulating androgen production in tilapia, but may not be essential and could be compensated.
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Affiliation(s)
- Lu Li
- Key Laboratory of Freshwater Fish Reproduction and Development (Ministry of Education), Key Laboratory of Aquatic Science of Chongqing, School of Life Science, Southwest University, Chongqing, 400715, PR China; Key Laboratory of Bio-resources and Eco-environment, Ministry of Education, College of Life Sciences, Sichuan University, Chengdu, 610065, China
| | - You Wu
- Key Laboratory of Freshwater Fish Reproduction and Development (Ministry of Education), Key Laboratory of Aquatic Science of Chongqing, School of Life Science, Southwest University, Chongqing, 400715, PR China
| | - Chenhua Zhao
- Key Laboratory of Freshwater Fish Reproduction and Development (Ministry of Education), Key Laboratory of Aquatic Science of Chongqing, School of Life Science, Southwest University, Chongqing, 400715, PR China
| | - Yiyang Miao
- Key Laboratory of Freshwater Fish Reproduction and Development (Ministry of Education), Key Laboratory of Aquatic Science of Chongqing, School of Life Science, Southwest University, Chongqing, 400715, PR China
| | - Jing Cai
- Key Laboratory of Freshwater Fish Reproduction and Development (Ministry of Education), Key Laboratory of Aquatic Science of Chongqing, School of Life Science, Southwest University, Chongqing, 400715, PR China
| | - Lingyun Song
- Key Laboratory of Freshwater Fish Reproduction and Development (Ministry of Education), Key Laboratory of Aquatic Science of Chongqing, School of Life Science, Southwest University, Chongqing, 400715, PR China
| | - Jing Wei
- Key Laboratory of Freshwater Fish Reproduction and Development (Ministry of Education), Key Laboratory of Aquatic Science of Chongqing, School of Life Science, Southwest University, Chongqing, 400715, PR China
| | | | - Limin Wu
- College of Fisheries, Henan Normal University, Xinxiang, Henan, 453007, China.
| | - Deshou Wang
- Key Laboratory of Freshwater Fish Reproduction and Development (Ministry of Education), Key Laboratory of Aquatic Science of Chongqing, School of Life Science, Southwest University, Chongqing, 400715, PR China.
| | - Linyan Zhou
- Key Laboratory of Freshwater Fish Reproduction and Development (Ministry of Education), Key Laboratory of Aquatic Science of Chongqing, School of Life Science, Southwest University, Chongqing, 400715, PR China.
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4
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Finn E, Kripps K, Chambers C, Rapp M, Meeks NJL, Xu F, Chen W, Larson AA, Nokoff NJ. A Novel Intronic Pathogenic Variant in STAR With a Dominant Negative Mechanism Causes Attenuated Lipoid Congenital Adrenal Hyperplasia. J Investig Med High Impact Case Rep 2021; 9:23247096211014685. [PMID: 33966472 PMCID: PMC8114284 DOI: 10.1177/23247096211014685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Lipoid congenital adrenal hyperplasia (LCAH) is typically inherited as an autosomal recessive condition. There are 3 reports of individuals with a dominantly acting heterozygous variant leading to a clinically significant phenotype. We report a 46,XY child with a novel heterozygous intronic variant in STAR resulting in LCAH with an attenuated genital phenotype. The patient presented with neonatal hypoglycemia and had descended testes with a fused scrotum and small phallus. Evaluation revealed primary adrenal insufficiency with deficiencies of cortisol, aldosterone, and androgens. He was found to have a de novo heterozygous novel variant in STAR: c.65-2A>C. We report a case of a novel variant and review of other dominant mutations at the same position in the literature. Clinicians should be aware of the possibility of attenuated genital phenotypes of LCAH and the contribution of de novo variants in STAR at c.65-2 to the pathogenesis of that phenotype.
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Affiliation(s)
- Erin Finn
- University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Kimberly Kripps
- University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | | | - Michele Rapp
- University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Naomi J L Meeks
- University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Fang Xu
- PreventionGenetics, Marshfield, WI, USA
| | | | - Austin A Larson
- University of Colorado Anschutz Medical Campus, Aurora, CO, USA
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Higa M, Zaha A, Takushi A, Morishima N, Majikina T, Touma T, Shimabukuro M, Masuzaki H, Honda M, Hasegawa T. Novel STAR gene variant in a patient with classic lipoid congenital adrenal hyperplasia and combined pituitary hormone deficiency. Hum Genome Var 2021; 8:6. [PMID: 33536409 PMCID: PMC7859387 DOI: 10.1038/s41439-021-00138-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Revised: 12/07/2020] [Accepted: 12/16/2020] [Indexed: 11/27/2022] Open
Abstract
We report the first case of classic lipoid congenital adrenal hyperplasia and combined pituitary hormone deficiency. We identified pathogenic variants in the STAR gene: a novel variant of c.126_127delCCinsG, namely, p.Thr44Profs*2 and an already reported variant of c.634C>T, namely, p.Gln212*. The association with combined pituitary hormone deficiency might be just a coincidence.
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Affiliation(s)
- Moritake Higa
- Diabetes and Lifestyle-Related Disease Center, Tomishiro Central Hospital, Okinawa, Japan
| | - Akiko Zaha
- Diabetes and Lifestyle-Related Disease Center, Tomishiro Central Hospital, Okinawa, Japan
| | - Akiko Takushi
- Diabetes and Lifestyle-Related Disease Center, Tomishiro Central Hospital, Okinawa, Japan
| | - Nami Morishima
- Diabetes and Lifestyle-Related Disease Center, Tomishiro Central Hospital, Okinawa, Japan
| | - Toyofumi Majikina
- Diabetes and Lifestyle-Related Disease Center, Tomishiro Central Hospital, Okinawa, Japan
| | - Takeshi Touma
- Diabetes and Lifestyle-Related Disease Center, Tomishiro Central Hospital, Okinawa, Japan
| | - Michio Shimabukuro
- Diabetes and Lifestyle-Related Disease Center, Tomishiro Central Hospital, Okinawa, Japan.,Department of Diabetes, Endocrinology, and Metabolism, Fukushima Medical University, Fukushima, Japan
| | - Hiroaki Masuzaki
- Division of Endocrinology, Diabetes and Metabolism, Hematology, Rheumatology, Department of Medicine, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan
| | - Misa Honda
- Department of Pediatrics, Keio University School of Medicine, Tokyo, Japan
| | - Tomonobu Hasegawa
- Department of Pediatrics, Keio University School of Medicine, Tokyo, Japan.
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6
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Zhang T, Ma X, Wang J, Jia C, Wang W, Dong Z, Ye L, Sun S, Hu R, Ning G, Li C, Lu W. Clinical and molecular characterization of thirty Chinese patients with congenital lipoid adrenal hyperplasia. J Steroid Biochem Mol Biol 2021; 206:105788. [PMID: 33227378 DOI: 10.1016/j.jsbmb.2020.105788] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 11/06/2020] [Accepted: 11/06/2020] [Indexed: 02/02/2023]
Abstract
Congenital lipoid adrenal hyperplasia (LCAH), as the most severe form of congenital adrenal hyperplasia (CAH), is caused by mutations in the steroidogenic acute regulatory protein (STAR). Affected patients were typically characterized by adrenal insufficiency in the first year of life and present with female external genitalia regardless of karyotype. Non-classic LCAH patients usually present from 2 to 4 years old with glucocorticoid deficiency and mild mineralocorticoid deficiency, even develop naturally masculinized external genitalia at birth when they have 46,XY karyotype. We described thirty patients from unrelated Chinese families, including three non-classic LCAH ones. Four novel mutations were reported, including c.556A > G, c.179-15G > T, c.695delG and c.306 + 3_c.306 + 6delAAGT. The c.772C > T is the most common STAR mutation in Chinese population, suggesting a possibility of founder effect. Enzymatic activity assay combined with clinical characteristics showed a good genotype-phenotype correlation in this study. Residual STAR activity more than 20 % may be correlated with non-classic LCAH phenotype. We support the perspective that onset age may be affected by multiple factors and masculinization should be the main weighting factor for diagnosis of non-classic LCAH. Compared with 46,XX LCAH patients, less 46,XY ones were found in our report. A less comprehensive inspection and an easy diagnosis due to classical phenotype both would reduce the possibility of 46,XY LCAH patients to be referred to specialists or geneticists.
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MESH Headings
- Adrenal Hyperplasia, Congenital/epidemiology
- Adrenal Hyperplasia, Congenital/genetics
- Adrenal Hyperplasia, Congenital/pathology
- Adrenal Insufficiency/genetics
- Adrenal Insufficiency/pathology
- Child, Preschool
- China/epidemiology
- Disorder of Sex Development, 46,XY/epidemiology
- Disorder of Sex Development, 46,XY/genetics
- Disorder of Sex Development, 46,XY/pathology
- Female
- Glucocorticoids/deficiency
- Glucocorticoids/genetics
- Humans
- Karyotype
- Male
- Mutation/genetics
- Phenotype
- Phosphoproteins/genetics
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Affiliation(s)
- Tingting Zhang
- Department of Pediatrics, Ruijin Hospital Affiliated to Shanghai Jiao Tong University, Shanghai, 200025, China
| | - Xiaoyu Ma
- Department of Pediatrics, Ruijin Hospital Affiliated to Shanghai Jiao Tong University, Shanghai, 200025, China
| | - Junqi Wang
- Department of Pediatrics, Ruijin Hospital Affiliated to Shanghai Jiao Tong University, Shanghai, 200025, China
| | - Caiwei Jia
- State Key Laboratory of Molecular Biology, Shanghai Institute of Biochemistry and Cell Biology, Center for Excellence in Molecular Cell Science, Chinese Academy of Sciences, Shanghai, 200031, China; University of Chinese Academy of Sciences, Beijing, 100049, China
| | - Wei Wang
- Department of Pediatrics, Ruijin Hospital Affiliated to Shanghai Jiao Tong University, Shanghai, 200025, China
| | - Zhiya Dong
- Department of Pediatrics, Ruijin Hospital Affiliated to Shanghai Jiao Tong University, Shanghai, 200025, China
| | - Lei Ye
- Department of Endocrine and Metabolic Diseases, Shanghai Clinical Center for Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
| | - Shouyue Sun
- Department of Endocrine and Metabolic Diseases, Shanghai Clinical Center for Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
| | - Ronggui Hu
- State Key Laboratory of Molecular Biology, Shanghai Institute of Biochemistry and Cell Biology, Center for Excellence in Molecular Cell Science, Chinese Academy of Sciences, Shanghai, 200031, China; University of Chinese Academy of Sciences, Beijing, 100049, China
| | - Guang Ning
- Department of Endocrine and Metabolic Diseases, Shanghai Clinical Center for Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China.
| | - Chuanyin Li
- State Key Laboratory of Molecular Biology, Shanghai Institute of Biochemistry and Cell Biology, Center for Excellence in Molecular Cell Science, Chinese Academy of Sciences, Shanghai, 200031, China; University of Chinese Academy of Sciences, Beijing, 100049, China.
| | - Wenli Lu
- Department of Pediatrics, Ruijin Hospital Affiliated to Shanghai Jiao Tong University, Shanghai, 200025, China.
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Holota H, Thirouard L, Monrose M, Garcia M, De Haze A, Saru JP, Caira F, Beaudoin C, Volle DH. FXRα modulates leydig cell endocrine function in mouse. Mol Cell Endocrinol 2020; 518:110995. [PMID: 32827571 DOI: 10.1016/j.mce.2020.110995] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 07/27/2020] [Accepted: 08/14/2020] [Indexed: 01/14/2023]
Abstract
The hypothalamic-pituitary axis exert a major control over endocrine and exocrine testicular functions. The hypothalamic-pituitary axis corresponds to a cascade with the Gonadotropin Releasing Hormone secreted by the hypothalamus, which stimulates the synthesis and the release of Luteinizing Hormone (LH) and Follicle Stimulating Hormone by the gonadotropic cells of the anterior pituitary. The LH signaling pathway controls the steroidogenic activity of the Leydig cells via the activation of the luteinizing hormone/choriogonadotropin receptor. In order to avoid a runaway system, sex steroids exert a negative feedback within hypothalamus and pituitary. Testicular steroidogenesis is locally controlled within Leydig cells. The present work reviews some local regulations of steroidogenesis within the Leydig cells focusing mainly on the roles of the Farnesoid-X-Receptor-alpha and its interactions with several orphan members of the nuclear receptor superfamily. Further studies are required to reinforce our knowledge of the regulation of testicular endocrine function, which is necessary to ensure a better understanding of fertility disorders and then proposed an adequate treatment of the diseases.
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Affiliation(s)
- Hélène Holota
- Inserm U1103, Université Clermont Auvergne, CNRS UMR-6293, GReD, F-63001, Clermont-Ferrand, France
| | - Laura Thirouard
- Inserm U1103, Université Clermont Auvergne, CNRS UMR-6293, GReD, F-63001, Clermont-Ferrand, France
| | - Mélusine Monrose
- Inserm U1103, Université Clermont Auvergne, CNRS UMR-6293, GReD, F-63001, Clermont-Ferrand, France
| | - Manon Garcia
- Inserm U1103, Université Clermont Auvergne, CNRS UMR-6293, GReD, F-63001, Clermont-Ferrand, France
| | - Angélique De Haze
- Inserm U1103, Université Clermont Auvergne, CNRS UMR-6293, GReD, F-63001, Clermont-Ferrand, France
| | - Jean-Paul Saru
- Inserm U1103, Université Clermont Auvergne, CNRS UMR-6293, GReD, F-63001, Clermont-Ferrand, France
| | - Françoise Caira
- Inserm U1103, Université Clermont Auvergne, CNRS UMR-6293, GReD, F-63001, Clermont-Ferrand, France
| | - Claude Beaudoin
- Inserm U1103, Université Clermont Auvergne, CNRS UMR-6293, GReD, F-63001, Clermont-Ferrand, France
| | - David H Volle
- Inserm U1103, Université Clermont Auvergne, CNRS UMR-6293, GReD, F-63001, Clermont-Ferrand, France.
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Garg M, Chugh V, Dutt Sharma S, Mitharwal P, Mangla A. Non-classical lipoid adrenal hyperplasia presenting as hypoglycemic seizures. J Pediatr Endocrinol Metab 2020; 33:1507-1509. [PMID: 32841165 DOI: 10.1515/jpem-2020-0211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Accepted: 07/05/2020] [Indexed: 11/15/2022]
Abstract
Introduction Primary adrenal insufficiency is a potentially life-threatening condition that can have many underlying causes. Mutations in the steroidogenic acute regulatory protein (StAR) gene produce lipoid congenital adrenal hyperplasia (LCAH) which usually presents in the infantile period with severe symptoms of adrenal insufficiency. Less commonly, a non-classical form is identified which may present at a later age in affected individuals. Till date, around 30 individuals with the non-classical form have been described. Case presentation We describe a 4-year-old 46, XX Indian girl who presented with hypoglycemic seizures and was subsequently diagnosed as non-classical LCAH on genetic analysis, with homozygous R188C mutation in the StAR gene. Conclusions StAR mutations may have a variety of clinical presentations and are likely under-diagnosed. Genetic diagnosis is important for treatment as well as monitoring of reproductive function.
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Affiliation(s)
- Meenal Garg
- Department of Pediatric Neurosciences, Surya Hospitals, Jaipur, India
| | - Vasundhara Chugh
- Department of Pediatric Endocrinology, Surya Hospitals, Jaipur, India
| | - Sunil Dutt Sharma
- Department of Pediatric Intensive Care, Surya Hospitals, Jaipur, India
| | | | - Ankit Mangla
- Department of Pediatric Intensive Care, Surya Hospitals, Jaipur, India
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Ishii T, Tajima T, Kashimada K, Mukai T, Tanahashi Y, Katsumata N, Kanno J, Hamajima T, Miyako K, Ida S, Hasegawa T. Clinical Features of 57 Patients with Lipoid Congenital Adrenal Hyperplasia: Criteria for Nonclassic Form Revisited. J Clin Endocrinol Metab 2020; 105:5896589. [PMID: 32835366 DOI: 10.1210/clinem/dgaa557] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Accepted: 08/14/2020] [Indexed: 02/13/2023]
Abstract
CONTEXT Lipoid congenital adrenal hyperplasia (LCAH) is caused by mutations in STAR. Classic (CLCAH) and nonclassic (NCLCAH) forms were reported as total and partial deficiencies, respectively, of adrenal and gonadal steroid hormones. The rarity of LCAH has precluded large-scale epidemiological and clinical investigations. OBJECTIVE To determine the epidemiological and clinical characteristics of 2 forms of LCAH. DESIGN A multicenter cross-sectional cohort study in Japan on December 1, 2017. PARTICIPANTS Fifty-seven patients with LCAH (median age, 23.7 years; range, 0.0-47.5 years). MAIN OUTCOME MEASURES Patient demographics, STAR genotype, Quigley grade, endocrinological and imaging data, treatment, and prognosis. RESULTS Fifty-three and 4 patients fulfilled definite and probable diagnostic criteria for LCAH, respectively. When NCLCAH was defined as either Quigley grade 1 in XY karyotype, no episode of salt losing or requirement of fludrocortisone, or onset of primary adrenal insufficiency (PAI) at 1 year or older, patients were divided into groups of 43 patients with CLCAH (75.4%), 11 with NCLCAH (19.3%), and 3 with unclassified LCAH (5.3%). All of the patients with CLCAH and 7/11 NCLCAH (63.6%) were treated with fludrocortisone. CLCAH was diagnosed at a significantly younger age than NCLCAH (median, 0.0 vs 4.0 years). STAR-Arg272Cys or -Met225Thr was identified only in NCLCAH (8/11, 72.7%). CONCLUSIONS We demonstrated the relative proportions and clinical and molecular characteristics of NCLCAH and CLCAH in Japan. These criteria for NCLCAH correspond to all previously published cases and our cases whose masculinization of the external genitalia, ability of mineralocorticoid production, and onset of PAI were described.
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MESH Headings
- Adolescent
- Adrenal Hyperplasia, Congenital/diagnosis
- Adrenal Hyperplasia, Congenital/drug therapy
- Adrenal Hyperplasia, Congenital/genetics
- Adult
- Child
- Child, Preschool
- Cross-Sectional Studies
- Disorder of Sex Development, 46,XY/diagnosis
- Disorder of Sex Development, 46,XY/drug therapy
- Disorder of Sex Development, 46,XY/genetics
- Female
- Fludrocortisone/therapeutic use
- Humans
- Infant
- Infant, Newborn
- Japan
- Middle Aged
- Mineralocorticoids/therapeutic use
- Mutation
- Phenotype
- Phosphoproteins/genetics
- Prognosis
- Young Adult
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Affiliation(s)
- Tomohiro Ishii
- Research Committee on Disorders of Adrenal Hormones, Research on Intractable Diseases, Health and Labour Sciences Research Grants, Tokyo, Japan
- Disorders of Sex Development and Adrenal Disorders Committee, the Japanese Society for Pediatric Endocrinology, Fushimi-ku, Kyoto, Japan
- Department of Pediatrics, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan
| | - Toshihiro Tajima
- Research Committee on Disorders of Adrenal Hormones, Research on Intractable Diseases, Health and Labour Sciences Research Grants, Tokyo, Japan
- Department of Pediatrics, Jichi Medical University Tochigi Children's Medical Center, Shimotsuke, Tochigi, Japan
| | - Kenichi Kashimada
- Research Committee on Disorders of Adrenal Hormones, Research on Intractable Diseases, Health and Labour Sciences Research Grants, Tokyo, Japan
- Disorders of Sex Development and Adrenal Disorders Committee, the Japanese Society for Pediatric Endocrinology, Fushimi-ku, Kyoto, Japan
- Department of Pediatrics and Developmental Biology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Tokuo Mukai
- Research Committee on Disorders of Adrenal Hormones, Research on Intractable Diseases, Health and Labour Sciences Research Grants, Tokyo, Japan
- Disorders of Sex Development and Adrenal Disorders Committee, the Japanese Society for Pediatric Endocrinology, Fushimi-ku, Kyoto, Japan
- Department of Pediatrics, Asahikawa-Kosei General Hospital, Asahikawa, Hokkaido, Japan
| | - Yusuke Tanahashi
- Research Committee on Disorders of Adrenal Hormones, Research on Intractable Diseases, Health and Labour Sciences Research Grants, Tokyo, Japan
- Department of Pediatrics, Asahikawa Medical University, Asahikawa, Hokkaido, Japan
| | - Noriyuki Katsumata
- Research Committee on Disorders of Adrenal Hormones, Research on Intractable Diseases, Health and Labour Sciences Research Grants, Tokyo, Japan
- Department of Molecular Endocrinology, National Research Institute for Child Health and Development, Tokyo, Japan
| | - Junko Kanno
- Disorders of Sex Development and Adrenal Disorders Committee, the Japanese Society for Pediatric Endocrinology, Fushimi-ku, Kyoto, Japan
- Department of Pediatrics, Tohoku University School of Medicine, Sendai, Miyagi, Japan
| | - Takashi Hamajima
- Disorders of Sex Development and Adrenal Disorders Committee, the Japanese Society for Pediatric Endocrinology, Fushimi-ku, Kyoto, Japan
- Department of Endocrinology and Metabolism, Aichi Children's Health and Medical Center, Obu, Aichi, Japan
| | - Kenichi Miyako
- Disorders of Sex Development and Adrenal Disorders Committee, the Japanese Society for Pediatric Endocrinology, Fushimi-ku, Kyoto, Japan
- Department of Endocrinology and Metabolism, Fukuoka Children's Hospital, Fukuoka, Fukuoka, Japan
| | - Shinobu Ida
- Disorders of Sex Development and Adrenal Disorders Committee, the Japanese Society for Pediatric Endocrinology, Fushimi-ku, Kyoto, Japan
- Department of Pediatric Gastroenterology and Endocrinology, Osaka Medical Center and Research Institute for Maternal and Child Health, Izumi, Osaka, Japan
| | - Tomonobu Hasegawa
- Research Committee on Disorders of Adrenal Hormones, Research on Intractable Diseases, Health and Labour Sciences Research Grants, Tokyo, Japan
- Department of Pediatrics, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan
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