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P450c17 Deficiency in Brazilian Patients: Biochemical Diagnosis through Progesterone Levels Confirmed by CYP17 Genotyping

Unidade de Endocrinologia do Desenvolvimento, Laboratório de Hormônios e Genética Molecular LIM/42, Divisão de Endocrinologia, Hospital das Clínicas da Faculdade de Medicina da Universidade de Sao Paulo (R.M.M., E.M.F.C., C.J.L., B.B.M.), Sao Paulo, S.P., Brazil; Hospital Universitário Regional do Norte do Paraná, Universidade Estadual de Londrina (M.L.d.O., A.C.), Londrina, PR, Brazil; Disciplina de Endocrinologia e Metabologia, Faculdade de Medicina de Marília (H.V.), Marília, SP, Brazil; and Unidade de Endocrinologia Pediátrica, Santa Casa de Sao Paulo (C.A.L.), Sao Paulo, SP, Brazil

Address all correspondence and requests for reprints to: Dr. Regina M. Martin or Dr. Berenice B. Mendonca, Unidade de Endocrinologia do Desenvolvimento, Laboratório de Hormônios e Genética Molecular LIM/42, Divisão de Endocrinologia, Hospital das Clínicas da Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, S.P., Brazil. E-mail: reginamm@usp.br orberemen{at}usp.br.

P450c17 deficiency is an autosomal recessive disorder and a rare cause of congenital adrenal hyperplasia characterized by hypertension, hypokalemia, and impaired production of sex hormones. We performed a clinical, hormonal, and molecular study of 11 patients from 6 Brazilian families with the combined 17-hydroxylase/17,20-lyase deficiency phenotype. All patients had elevated basal serum levels of progesterone (1.8–38 ng/ml; 0.57–12 pmol/liter) and suppressed plasma renin activity. CYP17 genotyping identified 5 missense mutations. The compound heterozygous mutation R362C/W406R was found in 1 family, whereas the homozygous mutations R96W, Y329D, and P428L were seen in the other 5 families. The R96W mutation has been described as the cause of P450c17 deficiency in Caucasian patients. The other mutations were not found in 50 normal subjects screened by allele-specific oligonucleotide hybridization (Y329D, R362C, and W406R) or digestion with HphI (P428L) and were recently found in other Brazilian patients. Therefore, we elucidated the genotype of 11 individuals with P450c17 deficiency and concluded that basal progesterone measurement is a useful marker of P450c17 deficiency and that its use should reduce the misdiagnosis of this deficiency in patients presenting with male pseudohermaphroditism, primary or secondary amenorrhea, and mineralocorticoid excess syndrome.

This work was supported by Grant 301246/95-5 from Conselho Nacional de Pesquisa (to B.B.M.).

Abbreviations: B, Corticosterone; DHEA, dehydroepiandrosterone; DHEAS, DHEA sulfate; DOC, 11-deoxycorticosterone; E₂, estradiol; 17OHP, 17-hydroxyprogesterone; P, progesterone.

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