A case of 3beta-hydroxysteroid dehydrogenase type II (HSD3B2) deficiency picked up by neonatal screening for 21-hydroxylase deficiency: difficulties and delay in etiologic diagnosis.
BACKGROUND
3beta-Hydroxysteroid dehydrogenase type II deficiency, a rare form of congenital adrenal hyperplasia, is characterized by varying degrees of salt loss and incomplete masculinization in males and mild virilization or normal external genitalia in females. The clinical signs may be difficult to recognize, increasing the risk of a neonatal adrenal crisis. In addition, elevated 17alpha-hydroxyprogesterone and androstenedione levels due to peripheral HSD3B1 activity may lead to a delay of the correct diagnosis and even to misdiagnosis as CYP21 deficiency.


METHODS
We report a patient who was detected on neonatal screening for 21-hydroxylase deficiency, in part because of cross-reactivity in the commonly used assay.


RESULTS
The diagnostic difficulties in this case were overcome by the use of more specific antibodies.


CONCLUSIONS
This case emphasizes the importance of confirming the etiological diagnosis with molecular genetic analyses.
Nordenström
Anna
A
Department of Pediatrics and PKU Laboratory, Stockholm, Sweden. Anna.Nordenstrom@ki.se
Forest
Maguelone G
MG
Wedell
Anna
A
D015096:3-Hydroxysteroid Dehydrogenases / Q000235:genetics*; D000312:Adrenal Hyperplasia, Congenital / Q000175:diagnosis* / Q000209:etiology* / Q000235:genetics; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D015997:Neonatal Screening
D015096:3-Hydroxysteroid Dehydrogenases