title: Severe combined adrenal and gonadal deficiency caused by novel mutations in the cholesterol side chain cleavage enzyme, P450scc.
abstract: BACKGROUND
  Mitochondrial cytochrome P450scc converts cholesterol to pregnenolone in all steroidogenic tissues. Although progesterone production from the fetally-derived placenta is necessary to maintain pregnancy to term, four patients with mutations in the gene encoding P450scc (CYP11A1), have been described, one in a 46,XX female and three in underandrogenized 46,XY individuals, all with primary adrenal failure.
  
  
  OBJECTIVE
  Our aim was to determine whether P450scc mutations might be found in other children and to explore genotype/phenotype correlations.
  
  
  METHODS
  We performed mutational analysis of CYP11A1 in individuals with 46,XY disorders of sex development and primary adrenal failure, followed by functional studies of P450scc activity and of P450scc RNA splicing.
  
  
  RESULTS
  Among nine 46,XY infants with adrenal failure and disordered sexual differentiation, two infants had compound heterozygous mutations in CYP11A1. One patient harbored the novel P450scc missense mutations L141W and V415E, which retained 38 and 0% activity, respectively. The other carried a CYP11A1 frameshift mutation c835delA (0% activity) and a splice site mutation [IVS3+(2-3)insT] that prevented correct splicing of P450scc mRNA.
  
  
  CONCLUSIONS
  P450scc deficiency is a recently recognized disorder that may be more frequent than originally thought. The phenotypic spectrum ranges from severe loss-of-function mutations associated with prematurity, complete underandrogenization, and severe, early-onset adrenal failure, to partial deficiencies found in children born at term with clitoromegaly and later-onset adrenal failure. In contradistinction to congenital lipoid adrenal hyperplasia caused by steroidogenic acute regulatory protein mutations, adrenal hyperplasia has not been reported in any of the six patients with P450scc deficiency.
authors.affiliation: Department of Pediatrics, University of California San Francisco, San Francisco, California 94143-0978, USA.
authors.forename: Chan Jong
authors.initials: CJ
authors.lastname: Kim
authors.forename: Lin
authors.initials: L
authors.lastname: Lin
authors.forename: Ningwu
authors.initials: N
authors.lastname: Huang
authors.forename: Charmian A
authors.initials: CA
authors.lastname: Quigley
authors.forename: Theodore W
authors.initials: TW
authors.lastname: AvRuskin
authors.forename: John C
authors.initials: JC
authors.lastname: Achermann
authors.forename: Walter L
authors.initials: WL
authors.lastname: Miller
mesh_terms: D000309:Adrenal Insufficiency; D002786:Cholesterol Side-Chain Cleavage Enzyme / Q000235:genetics*; D012734:Disorders of Sex Development; D005260:Female; D006061:Gonadal Dysgenesis, 46,XY / Q000235:genetics*; D006801:Humans; D009154:Mutation
chemical_list: D002786:Cholesterol Side-Chain Cleavage Enzyme