title: CYP21A2 gene mutations in congenital adrenal hyperplasia: genotype-phenotype correlation in Turkish children.
abstract: BACKGROUND
  Congenital adrenal hyperplasia (CAH) due 21-hydroxylase deficiency (21-OHD) is a common autosomal recessive disorder. It is caused by defects in the CYP21A2 gene.
  
  
  OBJECTIVE
  Our aim was to determine the frequency of common gene mutations and to evaluate genotype-phenotype correlations in Turkish 21-OHD patients.
  
  
  METHODS
  Molecular analysis of the CYP21A2 gene was performed for the detection of the eight most common point mutations [p.P30L, IVS2-13C>G (IVS-2), p.I172N, exon 6 mutation cluster (p.I236N, p.V237E, p.M239K), p.V281L, p.Q318X, p.R356W, 8-bp-deletion], of large deletion and conversion by southern blotting, allele specific semi-quantitative PCR/enzyme restriction method and sequencing, in 56 patients with 21-OHD, from 52 families.
  
  
  RESULTS
  Disease-causing mutations were identified in 77 out of 91 alleles (84.6%) of the patients. Mutations were found in 34 of 43 alleles (79.1%) in salt wasting (SW; n=26), 32 of 36 alleles (88.8%) in simple virilizing (SV; n=24) and 11 of 12 alleles (91.6%) in non-classical (NC; n=6) form of CAH. The most frequent mutations were IVS-2 (22.0%), large conversion (14.3%), p.I172N (9.9%) p.R356W (8.8%), and large deletion (6.6%). In the SW form, the most frequent genotypes were homozygous for IVS-2 (11.5%) and homozygous for large conversion of the gene (11.5%). In the SV form, the most frequent genotype was homozygous for IVS-2 (20%), followed by compound heterozygous for p.I172N/8-bp del (10%). Homozygous for p.V281L (16.7%) was most common in NC. In most cases there was good correlation between genotype and phenotype. In the SW and NC forms, genotypes of all the patients correlated with their phenotypes.
  
  
  CONCLUSIONS
  This is the first comprehensive study on the molecular basis of CAH patients in the Turkish population. Based on these results, we propose a modified screening strategy to facilitate molecular testing of CAH patients in our population.
authors.affiliation: Istanbul University, Istanbul Faculty of Medicine, Department of Pediatrics, Pediatric Endocrinology Unit, Istanbul, Turkey. firdevsbas@superonline.com
authors.forename: Firdevs
authors.initials: F
authors.lastname: Baş
authors.forename: Hülya
authors.initials: H
authors.lastname: Kayserili
authors.forename: Feyza
authors.initials: F
authors.lastname: Darendeliler
authors.forename: Oya
authors.initials: O
authors.lastname: Uyguner
authors.forename: Hülya
authors.initials: H
authors.lastname: Günöz
authors.forename: Memnune
authors.initials: M
authors.lastname: Yüksel Apak
authors.forename: Fatmahan
authors.initials: F
authors.lastname: Atalar
authors.forename: Rüveyde
authors.initials: R
authors.lastname: Bundak
authors.forename: Robert C
authors.initials: RC
authors.lastname: Wilson
authors.forename: Maria I
authors.initials: MI
authors.lastname: New
authors.forename: Bernd
authors.initials: B
authors.lastname: Wollnik
authors.forename: Nurçin
authors.initials: N
authors.lastname: Saka
mesh_terms: D000312:Adrenal Hyperplasia, Congenital / Q000201:enzymology* / Q000235:genetics*; D002648:Child; D004252:DNA Mutational Analysis; D005260:Female; D005787:Gene Frequency; D056726:Genetic Association Studies; D006801:Humans; D008297:Male; D009154:Mutation; D013255:Steroid 21-Hydroxylase / Q000235:genetics*; D014421:Turkey
chemical_list: C531510:CYP21A2 protein, human; D013255:Steroid 21-Hydroxylase