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A Novel Mutation L260P of the Steroidogenic Acute Regulatory Protein Gene in Three Unrelated Patients of Swiss Ancestry with Congenital Lipoid Adrenal Hyperplasia

Department of Pediatric Endocrinology and Diabetology (C.E.F., P.E.M.), University Children’s Hospital Bern, CH-3010 Bern, Switzerland; Endocrinology and Diabetology Unit (A.M., G.E.T.), Department of Pediatrics, University Hospital Lausanne, CH-1011 Lausanne, Switzerland; Biochimie Endocrinienne et Moléculaire (D.M., S.P.-D., Y.M.), Hospital Debrousse, University Claude Bernard, 69322 Lyon, France; Department of Medicine and Institute of Child Health (J.C.A.), University College London, London WC1N 1EH, United Kingdom; and Division of Pediatric Endocrinology (B.L.), University Hospital, 54003 Nancy, France

Address all correspondence and requests for reprints to: Yves Morel, M.D., Ph.D., Biochimie Endocrinienne et Moléculaire, Hopital Debrousse, 29 Rue Soeur Bouvier, F-69322 Lyon Cedex 05, France. E-mail: morel{at}lyon.inserm.fr.

Context: Lipoid congenital adrenal hyperplasia (CAH) is the most severe form of CAH leading to impaired production of all adrenal and gonadal steroids. Mutations in the gene encoding steroidogenic acute regulatory protein (StAR) cause lipoid CAH.

Objective: We investigated three unrelated patients of Swiss ancestry who all carried novel mutations in the StAR gene. All three subjects were phenotypic females with absent Müllerian derivatives, 46,XY karyotype, and presented with adrenal failure.

Methods and Results: StAR gene analysis showed that one patient was homozygous and the other two were heterozygous for the novel missense mutation L260P. Of the heterozygote patients, one carried the novel missense mutation L157P and one had a novel frameshift mutation (629–630delCT) on the second allele. The functional ability of all three StAR mutations to promote pregnenolone production was severely attenuated in COS-1 cells transfected with the cholesterol side-chain cleavage system and mutant vs. wild-type StAR expression vectors.

Conclusions: These cases highlight the importance of StAR-dependent steroidogenesis during fetal development and early infancy; expand the geographic distribution of this condition; and finally establish a new, prevalent StAR mutation (L260P) for the Swiss population.

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