Heterozygosis for CYP21A2 mutation considered as 21-hydroxylase deficiency in neonatal screening

• Autor(a) principal: Soardi, Fernanda Caroline
• Data de Publicação: 2008
• Outros Autores: Lemos-Marini, Sofia Helena Valente de, Coeli, Fernanda Borchers, Maturana, Víctor Gonçalves, Silva, Márcia Duarte Barbosa da, Bernardi, Renan Darin, Justo, Giselle Zenker [UNIFESP], Mello, Maricilda Palandi de
• Tipo de documento: Artigo
• Idioma: eng
• Título da fonte: Repositório Institucional da UNIFESP
• Texto Completo: https://dx.doi.org/10.1590/S0004-27302008000800030; https://repositorio.unifesp.br/handle/11600/4626
• topic: Neonatal screening; Minigenes; 21-hydroxylase deficiency; CYP21A2 mutations; Triagem neonatal; Mutações CYP21A2; Minigenes; Deficiência de 21-hidroxilase

Steroid 21-hydroxylase deficiency (21-OHD) accounts for more than 90% of congenital adrenal hyperplasia. CAH newborn screening, in general, is based on 17-hydroxyprogesterone dosage (17-OHP), however it is complicated by the fact that healthy preterm infants have high levels of 17-OHP resulting in false positive cases. We report on molecular features of a boy born pre-term (GA = 30 weeks; weight = 1,390 g) with elevated levels of 17-OHP (91.2 nmol/L, normal < 40) upon neonatal screening who was treated as having CAH up to the age of 8 months. He was brought to us for molecular diagnosis. Medication was gradually suspended and serum 17-OHP dosages mantained normal. The p.V281L mutation was found in compound heterozygous status with a group of nucleotide alterations located at the 3' end intron 4 and 5' end exon 5 corresponding to the splice site acceptor region. Molecular studies continued in order to exclude the possibility of a nonclassical 21-OHD form. The group of three nucleotide changes was demonstrated to be a normal variant since they failed to interfere with the normal splicing process upon minigene studies.