Nonclassic steroid 21-hydroxylase deficiency due to a homozygous V281L mutation in CYP21A2 detected by the neonatal mass-screening program in Japan.
Since 1989, neonatal mass screening for congenital adrenal hyperplasia (CAH) has been carried out in Japan. The mass screening has detected not only the patients with the classic form of steroid 21-hydroxylase deficiency (21-OHD), but also those with the nonclassic (NC) form of 21-OHD, and the molecular basis in these patients has been elucidated. However, the homozygous V281L mutation in CYP21A2, the common mutation in the NC form in Caucasians, has not been described in Japanese patients, implying at least two possibilities; 1) the V281L mutation itself might be very rare in Japanese, and 2) nonclassic 21-OHD patients bearing the V281L mutation might be barely detectable by the mass-screening program, hence overlooked in Japan. In the present study, we describe a Brazilian girl with the NC form of 21-OHD, who was pointed out to have mildly elevated 17 alpha-hydroxyprogesterone in blood by the mass screening in Japan. Genetic analysis revealed that the patient was homozygous for the V281L mutation, and that the parents were heterozygous for the V281L mutation. Thus, the NC patients due to the homozygous V281L mutation can be detectable by the mass-screening program for CAH in Japan, and further accumulation and analysis of the NC patients should elucidate the frequency of the V281L allele in Japan.
Department of Endocrinology and Metabolism, National Research Institute for Child Health and Development, Tokyo, Japan.
Takashi
T
Shinagawa
Reiko
R
Horikawa
Tsuyoshi
T
Isojima
Yasuhiro
Y
Naiki
Toshiaki
T
Tanaka
Noriyuki
N
Katsumata
D000312:Adrenal Hyperplasia, Congenital / Q000097:blood / Q000201:enzymology* / Q000235:genetics; D000450:Aldosterone / Q000097:blood; D001483:Base Sequence; D001938:Brazil / Q000208:ethnology; D004247:DNA / Q000737:chemistry / Q000235:genetics; D005260:Female; D006801:Humans; D006854:Hydrocortisone / Q000097:blood; D007231:Infant, Newborn; D007564:Japan; D008403:Mass Screening; D008969:Molecular Sequence Data; D009154:Mutation; D016133:Polymerase Chain Reaction; D013255:Steroid 21-Hydroxylase / Q000235:genetics* / Q000378:metabolism
D000450:Aldosterone; D004247:DNA; D013255:Steroid 21-Hydroxylase; D006854:Hydrocortisone