title: Gonadal function, first cases of pregnancy, and child delivery in a woman with lipoid congenital adrenal hyperplasia.
abstract: BACKGROUND
  Mutations in the steroidogenic acute regulatory protein (StAR) gene often cause lipoid congenital adrenal hyperplasia (LCAH). In this disorder an impairment of steroid synthesis leads to adrenal and gonadal insufficiencies with a particular female genital phenotype in both human karyotypes. Pregnancy in LCAH has not been yet reported.
  
  
  OBJECTIVE
  We describe the first cases of pregnancy in a LCAH female patient bearing the L275P mutation in the StAR gene.
  
  
  METHODS
  We studied the gonadal function, pubertal development, and apply the appropriate hormonal therapy to support pregnancies.
  
  
  METHODS
  A 46,xx patient of French Canadian descent was diagnosed with LCAH at the age of 4.5 months. Substitution therapy with glucocorticoids and mineralocorticoids led to normal growth and development. Progressive pubertal development started at the age of 11 7/12 yr. Menarche occurred at 14 2/12 yr with normal regular menstruations thereafter but without ovulation.
  
  
  RESULTS
  Clomiphene stimulation induced the first pregnancy at 25 4/12 yr of age. Spontaneous abortion occurred after 6 wk gestation. The second pregnancy (with clomiphene stimulation) was induced at the age of 26 yr. Progesterone (Prog) therapy was added at the 17th day of the cycle to protect pregnancy. Vaginal delivery of dichorionic-diamniotic twin pregnancy occurred at 30 wk gestation (two normal weight male babies). Two years later, again under clomiphene stimulation, she underwent another successful singleton pregnancy and delivered a normal weight female baby at 36 wk. The pregnancies were almost uncomplicated.
  
  
  CONCLUSIONS
  Despite the dysfunctional StAR, pregnancy is possible under the proper therapeutic strategy.
authors.affiliation: Departments of Pediatrics, Faculty of Medicine, University of Sherbrooke, Sherbrooke, Quebec, Canada.
authors.forename: Khalil
authors.initials: K
authors.lastname: Khoury
authors.forename: Elie
authors.initials: E
authors.lastname: Barbar
authors.forename: Youssef
authors.initials: Y
authors.lastname: Ainmelk
authors.forename: Annie
authors.initials: A
authors.lastname: Ouellet
authors.forename: Jean-Guy
authors.initials: JG
authors.lastname: Lehoux
mesh_terms: D000312:Adrenal Hyperplasia, Congenital / Q000503:physiopathology*; D000728:Androgens / Q000097:blood; D003687:Dehydroepiandrosterone / Q000097:blood; D004958:Estradiol / Q000097:blood; D005260:Female; D005313:Fetal Death; D005640:Follicle Stimulating Hormone / Q000097:blood; D006801:Humans; D007003:Hypoglycemia; D007231:Infant, Newborn; D007986:Luteinizing Hormone / Q000097:blood; D011247:Pregnancy; D011256:Pregnancy Outcome
chemical_list: D000728:Androgens; D003687:Dehydroepiandrosterone; D004958:Estradiol; D007986:Luteinizing Hormone; D005640:Follicle Stimulating Hormone