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Guran T, Kara C, Yildiz M, Bitkin EC, Haklar G, Lin JC, Keskin M, Barnard L, Anik A, Catli G, Guven A, Kirel B, Tutunculer F, Onal H, Turan S, Akcay T, Atay Z, Yilmaz GC, Mamadova J, Akbarzade A, Sirikci O, Storbeck KH, Baris T, Chung BC, Bereket A. Revisiting Classical 3β-hydroxysteroid Dehydrogenase 2 Deficiency: Lessons from 31 Pediatric Cases. J Clin Endocrinol Metab 2020; 105:5707567. [PMID: 31950145 DOI: 10.1210/clinem/dgaa022] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2019] [Accepted: 01/13/2020] [Indexed: 02/10/2023]
Abstract
CONTEXT The clinical effects of classical 3β-hydroxysteroid dehydrogenase 2 (3βHSD2) deficiency are insufficiently defined due to a limited number of published cases. OBJECTIVE To evaluate an integrated steroid metabolome and the short- and long-term clinical features of 3βHSD2 deficiency. DESIGN Multicenter, cross-sectional study. SETTING Nine tertiary pediatric endocrinology clinics across Turkey. PATIENTS Children with clinical diagnosis of 3βHSD2 deficiency. MAIN OUTCOME MEASURES Clinical manifestations, genotype-phenotype-metabolomic relations. A structured questionnaire was used to evaluate the data of patients with clinical 3βHSD2 deficiency. Genetic analysis of HSD3B2 was performed using Sanger sequencing. Novel HSD3B2 mutations were studied in vitro. Nineteen plasma adrenal steroids were measured using LC-MS/MS. RESULTS Eleven homozygous HSD3B2 mutations (6 novel) were identified in 31 children (19 male/12 female; mean age: 6.6 ± 5.1 yrs). The patients with homozygous pathogenic HSD3B2 missense variants of > 5% of wild type 3βHSD2 activity in vitro had a non-salt-losing clinical phenotype. Ambiguous genitalia was an invariable feature of all genetic males, whereas only 1 of 12 female patients presented with virilized genitalia. Premature pubarche was observed in 78% of patients. In adolescence, menstrual irregularities and polycystic ovaries in females and adrenal rest tumors and gonadal failure in males were observed. CONCLUSIONS Genetically-documented 3βHSD2 deficiency includes salt-losing and non-salt-losing clinical phenotypes. Spared mineralocorticoid function and unvirilized genitalia in females may lead to misdiagnosis and underestimation of the frequency of 3βHSD2 deficiency. High baseline 17OHPreg to cortisol ratio and low 11-oxyandrogen concentrations by LC-MS/MS unequivocally identifies patients with 3βHSD2 deficiency.
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Affiliation(s)
- Tulay Guran
- Department of Pediatric Endocrinology and Diabetes, School of Medicine, Marmara University, Istanbul, Turkey
| | - Cengiz Kara
- Department of Pediatric Endocrinology and Diabetes, Ondokuz Mayis University, Samsun, Turkey
| | - Melek Yildiz
- Department of Pediatric Endocrinology and Diabetes, Kanuni Sultan Suleyman Training and Research Hospital, Istanbul, Turkey
| | - Eda C Bitkin
- Department of Pediatric Endocrinology and Diabetes, Ondokuz Mayis University, Samsun, Turkey
| | - Goncagul Haklar
- Department of Biochemistry, School of Medicine, Marmara University, Istanbul, Turkey
| | - Jen-Chieh Lin
- Institute of Molecular Biology, Academia Sinica, Taipei, Taiwan
| | - Mehmet Keskin
- Department of Pediatric Endocrinology and Diabetes, Gaziantep University, Gaziantep, Turkey
| | - Lise Barnard
- Department of Biochemistry, Stellenbosch University, Western Cape, South Africa
| | - Ahmet Anik
- Department of Pediatric Endocrinology and Diabetes, School of Medicine, Aydin Adnan Menderes University, Aydin, Turkey
| | - Gonul Catli
- Department of Pediatric Endocrinology and Diabetes, School of Medicine, Katip Celebi University, Izmir, Turkey
| | - Ayla Guven
- Pediatric Endocrinology, Health Science University, Faculty of Medicine, Zeynep Kamil Women and Children Diseases Education and Research Hospital, Istanbul, Turkey
| | - Birgul Kirel
- Department of Pediatric Endocrinology, Eskisehir Osmangazi University, Eskisehir, Turkey
| | - Filiz Tutunculer
- Department of Pediatrics, Division of Pediatric Endocrinology, Trakya University School of Medicine, Edirne, Turkey
| | - Hasan Onal
- Department of Pediatric Endocrinology and Diabetes, Kanuni Sultan Suleyman Training and Research Hospital, Istanbul, Turkey
| | - Serap Turan
- Department of Pediatric Endocrinology and Diabetes, School of Medicine, Marmara University, Istanbul, Turkey
| | - Teoman Akcay
- Department of Pediatric Endocrinology and Diabetes, Istinye University Medical Park Gaziosmanpasa Hospital, Istanbul, Turkey
| | - Zeynep Atay
- Department of Pediatric Endocrinology and Diabetes, School of Medicine, Marmara University, Istanbul, Turkey
| | - Gulay C Yilmaz
- Department of Pediatric Endocrinology and Diabetes, Ondokuz Mayis University, Samsun, Turkey
| | - Jamala Mamadova
- Department of Pediatric Endocrinology and Diabetes, Ondokuz Mayis University, Samsun, Turkey
| | - Azad Akbarzade
- Department of Pediatric Endocrinology and Diabetes, School of Medicine, Marmara University, Istanbul, Turkey
| | - Onder Sirikci
- Department of Biochemistry, School of Medicine, Marmara University, Istanbul, Turkey
| | - Karl-Heinz Storbeck
- Department of Biochemistry, Stellenbosch University, Western Cape, South Africa
| | - Tugba Baris
- Gelisim Genetik Tani Merkezi, Istanbul, Turkey
| | - Bon-Chu Chung
- Institute of Molecular Biology, Academia Sinica, Taipei, Taiwan
| | - Abdullah Bereket
- Department of Pediatric Endocrinology and Diabetes, School of Medicine, Marmara University, Istanbul, Turkey
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