Congenital adrenal hyperplasia is a group of autosomal recessivedisorders resulting from the deficiency of one of the five enzymesrequired for the synthesis of cortisol in the adrenal cortex.The most frequent is steroid 21-hydroxylase deficiency, accountingfor more than 90 percent of cases. Since the last Medical Progressarticle on this topic was published in the Journal in 1987,1much has been learned about the genetics of the various clinicalforms of 21-hydroxylase deficiency, and correlations betweenthe genotype and the phenotype have been extensively studied.Gene-specific prenatal diagnosis is now feasible, and prenataltreatment has been more . . . [Full Text of this Article]
Biochemistry
Clinical Manifestations
Salt Wasting
Ambiguous Genitalia
Postnatal Virilization
Linear Growth
Reproductive Function
Presentation in Patients with Simple Virilizing 21-Hydroxylase Deficiency
Presentation in Patients with Nonclassic Disease
Presentation in Heterozygotes
Diagnosis
Genetics
Mutations
Correlations between Phenotype and Genotype
Treatment
Glucocorticoids
Mineralocorticoids
Management of Ambiguous Genitalia
Prenatal Diagnosis and Treatment
Novel Treatments
Source Information
From the Department of Pediatrics, Schneider Children's HospitalNorth ShoreLong Island Jewish Health System, New Hyde Park, N.Y. (P.W.S.); New York University Medical Center, New York (P.W.S.); and the Department of Pediatrics, University of Texas Southwestern Medical Center at Dallas, Dallas (P.C.W.).
Address reprint requests to Dr. Speiser at Schneider Children's Hospital, 269-01 76th Ave., New Hyde Park, NY 11042, or at pspeiser@LIJ.edu.
This article has been cited by other articles:
Bonfig, W., Dalla Pozza, S. B., Schmidt, H., Pagel, P., Knorr, D., Schwarz, H. P.
(2009). Hydrocortisone Dosing during Puberty in Patients with Classical Congenital Adrenal Hyperplasia: An Evidence-Based Recommendation. J. Clin. Endocrinol. Metab.
94: 3882-3888
[Abstract][Full Text]
Kleinle, S., Lang, R., Fischer, G. F., Vierhapper, H., Waldhauser, F., Fodinger, M., Baumgartner-Parzer, S. M.
(2009). Duplications of the Functional CYP21A2 Gene Are Primarily Restricted to Q318X Alleles: Evidence for a Founder Effect. J. Clin. Endocrinol. Metab.
94: 3954-3958
[Abstract][Full Text]
Cavarzere, P., Samara-Boustani, D., Flechtner, I., Dechaux, M., Elie, C., Tardy, V., Morel, Y., Polak, M.
(2009). Transient hyper-17-hydroxyprogesteronemia: a clinical subgroup of patients diagnosed at neonatal screening for congenital adrenal hyperplasia. Eur J Endocrinol
161: 285-292
[Abstract][Full Text]
Schreiner, F., Tozakidou, M., Maslak, R., Holtkamp, U., Peter, M., Gohlke, B., Woelfle, J.
(2009). Functional glucocorticoid receptor gene variants do not underlie the high variability of 17-hydroxyprogesterone screening values in healthy newborns. Eur J Endocrinol
160: 667-673
[Abstract][Full Text]
Mullins, L. J., Peter, A., Wrobel, N., McNeilly, J. R., McNeilly, A. S., Al-Dujaili, E. A. S., Brownstein, D. G., Mullins, J. J., Kenyon, C. J.
(2009). Cyp11b1 Null Mouse, a Model of Congenital Adrenal Hyperplasia. J. Biol. Chem.
284: 3925-3934
[Abstract][Full Text]
Balestrieri, A., Zirilli, L., Madeo, B., Pignatti, E., Rossi, G., Carani, C., Rochira, V.
(2008). 21-Hydroxylase Deficiency and Klinefelter Syndrome in an Adult Man: Striking a Balance Between Androgen Excess and Insufficiency. J Androl
29: 605-609
[Full Text]
Gomes, L. G., Huang, N., Agrawal, V., Mendonca, B. B., Bachega, T. A. S. S., Miller, W. L.
(2008). The Common P450 Oxidoreductase Variant A503V Is Not a Modifier Gene for 21-Hydroxylase Deficiency. J. Clin. Endocrinol. Metab.
93: 2913-2916
[Abstract][Full Text]
Menassa, R., Tardy, V., Despert, F., Bouvattier-Morel, C., Brossier, J. P., Cartigny, M., Morel, Y.
(2008). p.H62L, a Rare Mutation of the CYP21 Gene Identified in Two Forms of 21-Hydroxylase Deficiency. J. Clin. Endocrinol. Metab.
93: 1901-1908
[Abstract][Full Text]
Soon, P. S. H., McDonald, K. L., Robinson, B. G., Sidhu, S. B.
(2008). Molecular Markers and the Pathogenesis of Adrenocortical Cancer. The Oncologist
13: 548-561
[Abstract][Full Text]
Parajes, S., Quinterio, C., Dominguez, F., Loidi, L.
(2007). A Simple and Robust Quantitative PCR Assay to Determine CYP21A2 Gene Dose in the Diagnosis of 21-Hydroxylase Deficiency. Clin. Chem.
53: 1577-1584
[Abstract][Full Text]
Dhir, V., Ivison, H. E., Krone, N., Shackleton, C. H. L., Doherty, A. J., Stewart, P. M., Arlt, W.
(2007). Differential Inhibition of CYP17A1 and CYP21A2 Activities by the P450 Oxidoreductase Mutant A287P. Mol. Endocrinol.
21: 1958-1968
[Abstract][Full Text]
Nabhan, Z. M., Eugster, E. A.
(2007). Upper-Tract Genitourinary Malformations in Girls With Congenital Adrenal Hyperplasia. Pediatrics
120: e304-e307
[Abstract][Full Text]
Bonfig, W., Bechtold, S., Schmidt, H., Knorr, D., Schwarz, H. P.
(2007). Reduced Final Height Outcome in Congenital Adrenal Hyperplasia under Prednisone Treatment: Deceleration of Growth Velocity during Puberty. J. Clin. Endocrinol. Metab.
92: 1635-1639
[Abstract][Full Text]
Baumgartner-Parzer, S. M., Fischer, G., Vierhapper, H.
(2007). Predisposition for de Novo Gene Aberrations in the Offspring of Mothers with a Duplicated CYP21A2 Gene. J. Clin. Endocrinol. Metab.
92: 1164-1167
[Abstract][Full Text]
Sartorato, P., Zulian, E., Benedini, S., Mariniello, B., Schiavi, F., Bilora, F., Pozzan, G., Greggio, N., Pagnan, A., Mantero, F., Scaroni, C.
(2007). Cardiovascular Risk Factors and Ultrasound Evaluation of Intima-Media Thickness at Common Carotids, Carotid Bulbs, and Femoral and Abdominal Aorta Arteries in Patients with Classic Congenital Adrenal Hyperplasia due to 21-Hydroxylase Deficiency. J. Clin. Endocrinol. Metab.
92: 1015-1018
[Abstract][Full Text]
Moran, C., Azziz, R., Weintrob, N., Witchel, S. F., Rohmer, V., Dewailly, D., Marcondes, J. A. M., Pugeat, M., Speiser, P. W., Pignatelli, D., Mendonca, B. B., Bachega, T. A. S., Escobar-Morreale, H. F., Carmina, E., Fruzzetti, F., Kelestimur, F.
(2006). Reproductive Outcome of Women with 21-Hydroxylase-Deficient Nonclassic Adrenal Hyperplasia. J. Clin. Endocrinol. Metab.
91: 3451-3456
[Abstract][Full Text]
Kushnir, M. M., Rockwood, A. L., Roberts, W. L., Pattison, E. G., Owen, W. E., Bunker, A. M., Meikle, A. W.
(2006). Development and Performance Evaluation of a Tandem Mass Spectrometry Assay for 4 Adrenal Steroids. Clin. Chem.
52: 1559-1567
[Abstract][Full Text]
Janner, M., Pandey, A. V, Mullis, P. E, Fluck, C. E
(2006). Clinical and biochemical description of a novel CYP21A2 gene mutation 962_963insA using a new 3D model for the P450c21 protein.. Eur J Endocrinol
155: 143-151
[Abstract][Full Text]
Krone, N., Grischuk, Y., Muller, M., Volk, R. E., Grotzinger, J., Holterhus, P.-M., Sippell, W. G., Riepe, F. G.
(2006). Analyzing the Functional and Structural Consequences of Two Point Mutations (P94L and A368D) in the CYP11B1 Gene Causing Congenital Adrenal Hyperplasia Resulting from 11-Hydroxylase Deficiency. J. Clin. Endocrinol. Metab.
91: 2682-2688
[Abstract][Full Text]
Luczay, A, Torok, D, Ferenczi, A, Majnik, J, Solyom, J, Fekete, G.
(2006). Potential advantage of N363S glucocorticoid receptor polymorphism in 21-hydroxylase deficiency.. Eur J Endocrinol
154: 859-864
[Abstract][Full Text]
Claahsen-van der Grinten, H. L., Noordam, K., Borm, G. F., Otten, B. J.
(2006). Absence of Increased Height Velocity in the First Year of Life in Untreated Children with Simple Virilizing Congenital Adrenal Hyperplasia. J. Clin. Endocrinol. Metab.
91: 1205-1209
[Abstract][Full Text]
Nebesio, T. D., Eugster, E. A.
(2006). Pubic Hair of Infancy: Endocrinopathy or Enigma?. Pediatrics
117: 951-954
[Abstract][Full Text]
Krone, N., Riepe, F. G., Gotze, D., Korsch, E., Rister, M., Commentz, J., Partsch, C.-J., Grotzinger, J., Peter, M., Sippell, W. G.
(2005). Congenital Adrenal Hyperplasia Due to 11-Hydroxylase Deficiency: Functional Characterization of Two Novel Point Mutations and a Three-Base Pair Deletion in the CYP11B1 Gene. J. Clin. Endocrinol. Metab.
90: 3724-3730
[Abstract][Full Text]
Kochli, A., Tenenbaum-Rakover, Y., Leshem, M.
(2005). Increased salt appetite in patients with congenital adrenal hyperplasia 21-hydroxylase deficiency. Am. J. Physiol. Regul. Integr. Comp. Physiol.
288: R1673-R1681
[Abstract][Full Text]
Baumgartner-Parzer, S. M., Nowotny, P., Heinze, G., Waldhausl, W., Vierhapper, H.
(2005). Carrier Frequency of Congenital Adrenal Hyperplasia (21-Hydroxylase Deficiency) in a Middle European Population. J. Clin. Endocrinol. Metab.
90: 775-778
[Abstract][Full Text]
Krone, N., Riepe, F. G., Grotzinger, J., Partsch, C.-J., Sippell, W. G.
(2005). Functional Characterization of Two Novel Point Mutations in the CYP21 Gene Causing Simple Virilizing Forms of Congenital Adrenal Hyperplasia Due to 21-Hydroxylase Deficiency. J. Clin. Endocrinol. Metab.
90: 445-454
[Abstract][Full Text]
Bergamaschi, R., Livieri, C., Candeloro, E., Uggetti, C., Franciotta, D., Cosi, V.
(2004). Congenital Adrenal Hyperplasia and Multiple Sclerosis: Is There an Increased Risk of Multiple Sclerosis in Individuals With Congenital Adrenal Hyperplasia?. Arch Neurol
61: 1953-1955
[Abstract][Full Text]
Minutti, C. Z., Lacey, J. M., Magera, M. J., Hahn, S. H., McCann, M., Schulze, A., Cheillan, D., Dorche, C., Chace, D. H., Lymp, J. F., Zimmerman, D., Rinaldo, P., Matern, D.
(2004). Steroid Profiling by Tandem Mass Spectrometry Improves the Positive Predictive Value of Newborn Screening for Congenital Adrenal Hyperplasia. J. Clin. Endocrinol. Metab.
89: 3687-3693
[Abstract][Full Text]
Charmandari, E., Merke, D. P., Negro, P. J., Keil, M. F., Martinez, P. E., Haim, A., Gold, P. W., Chrousos, G. P.
(2004). Endocrinologic and Psychologic Evaluation of 21-Hydroxylase Deficiency Carriers and Matched Normal Subjects: Evidence for Physical and/or Psychologic Vulnerability to Stress. J. Clin. Endocrinol. Metab.
89: 2228-2236
[Abstract][Full Text]
Marsden, D., Larson, C. A.
(2004). Emerging Role for Tandem Mass Spectrometry in Detecting Congenital Adrenal Hyperplasia. Clin. Chem.
50: 467-468
[Full Text]
Lacey, J. M., Minutti, C. Z., Magera, M. J., Tauscher, A. L., Casetta, B., McCann, M., Lymp, J., Hahn, S. H., Rinaldo, P., Matern, D.
(2004). Improved Specificity of Newborn Screening for Congenital Adrenal Hyperplasia by Second-Tier Steroid Profiling Using Tandem Mass Spectrometry. Clin. Chem.
50: 621-625
[Abstract][Full Text]