Disease expression and molecular genotype in congenital adrenal hyperplasia due to 21-hydroxylase deficiency

Phyllis W. Speiser, Jakob Dupont, Deguang Zhu, Jorge Serrat, Miriam Buegeleisen, Maria Teresa Tusie-Luna, Martin Lesser, Maria I. New, Perrin C. White

Research output: Contribution to journalArticle

464 Scopus citations

Abstract

Genotyping for 10 mutations in the CYP21 gene was performed in 88 families with congenital adrenal hyperplasia due to 21-hydroxylase deficiency. Southern blot analysis was used to detect CYP21 deletions or large gene conversions, and allele-specific hybridizations were performed with DNA amplified by the polymerase chain reaction to detect smaller mutations. Mutations were detected on 95% of chromosomes examined. The most common mutations were an A → G change in the second intron affecting pre-mRNA splicing (26%), large deletions (21%), Ile-172 → Asn (16%), and Val-281 → Leu (11%). Patients were classified into three mutation groups based on degree of predicted enzymatic compromise. Mutation groups were correlated with clinical diagnosis and specific measures of in vivo 21-hydroxylase activity, such as 17-hydroxyprogesterone, aldosterone, and sodium balance. Mutation group A (no enzymatic activity) consisted principally of salt- wasting (severely affected) patients, group B (2% activity) of simple virilizing patients, and group C (10-20% activity) of nonclassic (mildly affected) patients, but each group contained patients with phenotypes either more or less severe than predicted. These data suggest that most but not all of the phenotypic variability in 21-hydroxylase deficiency results from allelic variation in CYP21. Accurate prenatal diagnosis should be possible in most cases using the described strategy.

Original languageEnglish (US)
Pages (from-to)584-595
Number of pages12
JournalJournal of Clinical Investigation
Volume90
Issue number2
DOIs
StatePublished - 1992

Keywords

  • CYP21
  • allelic variation
  • steroid 21-hydroxylase deficiency

ASJC Scopus subject areas

  • Medicine(all)

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    Speiser, P. W., Dupont, J., Zhu, D., Serrat, J., Buegeleisen, M., Tusie-Luna, M. T., Lesser, M., New, M. I., & White, P. C. (1992). Disease expression and molecular genotype in congenital adrenal hyperplasia due to 21-hydroxylase deficiency. Journal of Clinical Investigation, 90(2), 584-595. https://doi.org/10.1172/JCI115897