Six Cases of Congenital Adrenal Hyperplasia That Were Due to 17alpha-hydroxylase/17,20-lyase Deficiency.

Dong Hoon Shin; Sung Hoon Yu; Young Min Choi; Jung Gu Kim; Sang Wan Kim; Chan Soo Shin; Kyong Soo Park; Seong Yeon Kim

doi:10.3803/jkes.2009.24.2.109

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Original Article Six Cases of Congenital Adrenal Hyperplasia That Were Due to 17alpha-hydroxylase/17,20-lyase Deficiency.: Dong Hoon Shin, Sung Hoon Yu, Young Min Choi, Jung Gu Kim, Sang Wan Kim, Chan Soo Shin, Kyong Soo Park, Seong Yeon Kim; Endocrinology and Metabolism 2009;24(2):109-115
DOI: https://doi.org/10.3803/jkes.2009.24.2.109
Published online: June 1, 2009

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¹Department of Internal Medicine, Hanil General Hospital, Korea.
²Department of Internal Medicine, Seoul National University College of Medicine, Korea.
³Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Korea.

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Abstract

17alpha-hydroxylase/17,20-lyase deficiency is a rare phenotype of congenital adrenal hyperplasia (CAH), and this is characterized by hyporeninemic hypertension, primary amenorrhea and abnormality of the secondary sexual characteristics (pseudohermaphroditism in men). This type of CAH is usually misdiagnosed at first as mineralocorticoid induced hypertension with primary aldosteronism, but primary amenorrhea with deficient sex hormone is a clue for making the correct diagnosis. The authors experienced 6 cases of 17alpha-hydroxylase/17,20-lyase deficiency in patients who ranged from 15 to 42 years of age. 4 cases were diagnosed according to the investigation of their mineralocorticoid-induced hypertension and 2 cases their primary amenorrhea and sexual infantilism. All of them had hypokalemia, hyporeninemic hypertension and an atrophied uterus and ovaries. In the genotypic male (46 XY), the testicles were atrophied in the abdominal cavity. The levels of cortisol, estrogen and dehydroepiandrosterone sulfate (DHEAS) were low, but the levels of progesterone and 11-deoxycorticosterone were high. Therefore, the diagnosis of 17alpha-hydroxylase/17,20-lyase deficiency should be considered in female patients who present with both sexual infantilism and mineralocorticoid hypertension. We report on these cases with a brief review of the literature.

Keywords: congenital adrenal hyperplasia;sexual infantilism;17alpha-hydroxylase/17,20-lyase deficiency;

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