title: Clinical course of patients with nonclassical 21-hydroxylase deficiency (21-OHD) diagnosed in infancy and childhood.
abstract: We report four cases of nonclassical 21-hydroxylase deficiency (21-OHD) diagnosed in neonate or early childhood. The four patients comprised a 6-year, 5-month-old male (case 1); a 3-year, 10-month-old female (case 2); a 13-year, 11-month-old female (case 3) and a 17-year, 1-month-old male (case 4). Cases 3 and 4 were siblings. None had any signs of virilization or salt wasting at birth. 21-OHD was diagnosed using ACTH loading test and other adrenal steroid evaluations. Mutations of the CYP21 gene were detected in all patients. Three patients (cases 1, 3 and 4) had positive results in neonatal mass screening. Cases 1 and 2 showed no apparent signs of virilization and were observed without conventional treatment. In cases 3 and 4, because of increased growth velocity and accelerated bone maturation, hydrocortisone administration was initiated from their late infantile period. In spite of hydrocortisone treatment, in case 4, the final height of 159.7 cm was less than his predicted final height. Besides he revealed adrenal insufficiency at the age of 9 years and 2 months old caused by viral infection. Hydrocortisone supplementation therapy may cause adrenal insufficiency in nonclassical patients due to suppression of the hypothalamus-pituitary-adrenal axis. The clinical courses in these cases were various, and it was difficult to predict the appearance of any symptoms of virilization. Careful observation is necessary.
authors.affiliation: Department of Human Ontogeny and Childhood Development, Tokyo Medical and Dental University, Bunkyo-ku, Yushima, Tokyo, Japan.
authors.forename: Ken-ichi
authors.initials: K
authors.lastname: Kashimada
authors.forename: Makoto
authors.initials: M
authors.lastname: Ono
authors.forename: Toshikazu
authors.initials: T
authors.lastname: Onishi
authors.forename: Satimi
authors.initials: S
authors.lastname: Koyama
authors.forename: Takio
authors.initials: T
authors.lastname: Toyoura
authors.forename: Kazuhide
authors.initials: K
authors.lastname: Imai
authors.forename: Sumitaka
authors.initials: S
authors.lastname: Saisho
authors.forename: Shuki
authors.initials: S
authors.lastname: Mizutani
mesh_terms: D000293:Adolescent; D000312:Adrenal Hyperplasia, Congenital / Q000175:diagnosis* / Q000188:drug therapy / Q000235:genetics*; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D005260:Female; D048788:Growth and Development / Q000235:genetics; D006801:Humans; D006854:Hydrocortisone / Q000627:therapeutic use; D008297:Male; D010375:Pedigree; D011379:Prognosis; D013255:Steroid 21-Hydroxylase / Q000235:genetics*
chemical_list: D000893:Anti-Inflammatory Agents; D013255:Steroid 21-Hydroxylase; D006854:Hydrocortisone