Skip to content
2000
Volume 24, Issue 14
  • ISSN: 1871-5303
  • E-ISSN: 2212-3873

Abstract

Background

Adrenal Hypoplasia Congenita (AHC) is a rare subtype of primary adrenal insufficiency (PAI) that can go undiagnosed easily. In this article, we report two brothers with hypogonadotropic hypogonadism and novel mutations in the NR0B1 gene who were misdiagnosed and mismanaged as having congenital adrenal hypoplasia (CAH) for several years.

Case Presentation

Herein, we describe two brothers with similar histories; first, they were diagnosed with CAH and treated for that; however, after several years, they showed symptoms of lack of testosterone despite receiving CAH treatment. Low levels of testosterone and LH were detected in both, and a genetic test of CAH was negative for the first brother. Thereafter, DAX-1 deficiency was suspected, and their genetic tests (the NR0B1 gene) confirmed the diagnosis of DAX-1.

Conclusion

The diagnosis of CAH in case of low levels of 17- OHP, testosterone, and LH, as well as central hypogonadotropic hypogonadism, should be studied, and further investigations are mandatory to evaluate other subtypes of PAI, especially AHC.

Loading

Article metrics loading...

/content/journals/emiddt/10.2174/0118715303285405240202092244
2024-02-21
2025-01-10
Loading full text...

Full text loading...

References

  1. KumarR. WassifW.S. Adrenal insufficiency.J. Clin. Pathol.202275743544210.1136/jclinpath‑2021‑20789535534201
    [Google Scholar]
  2. BowdenS.A. Current screening strategies for the diagnosis of adrenal insufficiency in children.Pediatric Health Med. Ther.20231411713010.2147/PHMT.S33457637051221
    [Google Scholar]
  3. HubskaJ. Kępczyńska-NykA. Czady-JurszewiczK. AmbroziakU. Characteristics of congenital adrenal hyperplasia diagnosed in adulthood: A literature review and case series.J. Clin. Med.202312265310.3390/jcm1202065336675589
    [Google Scholar]
  4. UslarT. OlmosR. Martínez-AguayoA. BaudrandR. Clinical update on congenital adrenal hyperplasia: Recommendations from a multidisciplinary adrenal program.J. Clin. Med.2023129312810.3390/jcm1209312837176569
    [Google Scholar]
  5. WuS. GaoJ. HeB. LongW. LuoX. ChenL. A novel NR0B1 gene mutation causes different phenotypes in two male patients with congenital adrenal hypoplasia.Curr. Med. Sci.202040117217710.1007/s11596‑020‑2161‑932166680
    [Google Scholar]
  6. Claahsen - van der Grinten, H.L.; Speiser, P.W.; Ahmed, S.F.; Arlt, W.; Auchus, R.J.; Falhammar, H.; Flück, C.E.; Guasti, L.; Huebner, A.; Kortmann, B.B.M.; Krone, N.; Merke, D.P.; Miller, W.L.; Nordenström, A.; Reisch, N.; Sandberg, D.E.; Stikkelbroeck, N.M.M.L.; Touraine, P.; Utari, A.; Wudy, S.A.; White, P.C. Congenital adrenal hyperplasia—current insights in pathophysiology, diagnostics, and management.Endocr. Rev.20224319115910.1210/endrev/bnab01633961029
    [Google Scholar]
  7. MallappaA. MerkeD.P. Management challenges and therapeutic advances in congenital adrenal hyperplasia.Nat. Rev. Endocrinol.202218633735210.1038/s41574‑022‑00655‑w35411073
    [Google Scholar]
  8. MaherJ.Y. Gomez-LoboV. MerkeD.P. The management of congenital adrenal hyperplasia during preconception, pregnancy, and postpartum.Rev. Endocr. Metab. Disord.2023241718310.1007/s11154‑022‑09770‑536399318
    [Google Scholar]
  9. Martin-GraceJ. DineenR. SherlockM. ThompsonC.J. Adrenal insufficiency: Physiology, clinical presentation and diagnostic challenges. Clinica chimica acta.Intern. J. Clin. Chem.20205057891
    [Google Scholar]
  10. BuonocoreF. McGlacken-ByrneS.M. del ValleI. AchermannJ.C. Current insights into adrenal insufficiency in the newborn and young infant.Front Pediatr.2020861904110.3389/fped.2020.61904133381483
    [Google Scholar]
  11. HowardS.R. DunkelL. Delayed puberty-phenotypic diversity, molecular genetic mechanisms, and recent discoveries.Endocr. Rev.20194051285131710.1210/er.2018‑0024831220230
    [Google Scholar]
  12. LotfiC.F.P. KremerJ.L. dos Santos PassaiaB. CavalcanteI.P. The human adrenal cortex: Growth control and disorders.Clinics2018731e473s10.6061/clinics/2018/e473s30208164
    [Google Scholar]
  13. Abou NaderN. BoyerA. Adrenal cortex development and maintenance: Knowledge acquired from mouse models.Endocrinology202116212bqab18710.1210/endocr/bqab18734473283
    [Google Scholar]
  14. ÇamtosunE. Dündarİ. AkıncıA. KayaşL. ÇiftçiN. Pediatric primary adrenal insufficiency: A 21-year single center experience.J. Clin. Res. Pediatr. Endocrinol.2021131889910.4274/jcrpe.galenos.2020.2020.013232938577
    [Google Scholar]
  15. CapalboD. MoracasC. CappaM. BalsamoA. MaghnieM. WasniewskaM.G. GreggioN.A. BaronioF. BizzarriC. FerroG. Di LascioA. StancampianoM.R. AzzoliniS. PattiG. LonghiS. ValenziseM. RadettiG. BetterleC. RussoG. SalernoM. Primary adrenal insufficiency in childhood: Data from a large nationwide cohort.J. Clin. Endocrinol. Metab.2021106376277310.1210/clinem/dgaa88133247909
    [Google Scholar]
  16. SzeligaA. KunickiM. Maciejewska-JeskeM. RzewuskaN. KostrzakA. MeczekalskiB. BalaG. SmolarczykR. AdashiE.Y. The genetic backdrop of hypogonadotropic hypogonadism.Int. J. Mol. Sci.202122241324110.3390/ijms22241324134948037
    [Google Scholar]
  17. WijayaM. HuameiM. JunZ. DuM. LiY. ChenQ. ChenH. SongG. Etiology of primary adrenal insufficiency in children: A 29-year single-center experience.J. Pediatr. Endocrinol. Metab.201932661562210.1515/jpem‑2018‑044531141483
    [Google Scholar]
  18. García-AceroM. MolinaM. MorenoO. RamirezA. ForeroC. CéspedesC. PrietoJ.C. PérezJ. Suárez-ObandoF. RojasA. Gene dosage of DAX-1, determining in sexual differentiation: duplication of DAX-1 in two sisters with gonadal dysgenesis.Mol. Biol. Rep.20194632971297810.1007/s11033‑019‑04758‑y30879272
    [Google Scholar]
  19. StickelsR. ClarkK. HeiderT.N. MattiskeD.M. RenfreeM.B. PaskA.J. DAX1/NR0B1 was expressed during mammalian gonadal development and gametogenesis before it was recruited to the eutherian X chromosome.Biol. Reprod.20159212210.1095/biolreprod.114.11936225395677
    [Google Scholar]
  20. HasegawaY. TakahashiY. KezukaY. ObaraW. KatoY. TamuraS. OnoderaK. SegawaT. OdaT. SatoM. NataK. NonakaT. IshigakiY. Identification and analysis of a novel NR0B1 mutation in late-onset adrenal hypoplasia congenita and hypogonadism.J. Endocr. Soc.202152bvaa17610.1210/jendso/bvaa17633381670
    [Google Scholar]
  21. LiuS. YanL. ZhouX. ChenC. WangD. YuanG. Delayed-onset adrenal hypoplasia congenita and hypogonadotropic hypogonadism caused by a novel mutation in DAX1.J. Int. Med. Res.202048210.1177/030006051988215131642359
    [Google Scholar]
  22. DandaS. MohanS. MathaiS. SimonA. Novel mutation in the nuclear receptor subfamily 0, group B, member 1 (NR0B1) gene associated with intrafamilial heterogeneity in three boys with X-linked adrenal hypoplasia congenita and hypogonadotropic hypogonadism from India.Natl. Med. J. India201932314114310.4103/0970‑258X.27869232129306
    [Google Scholar]
  23. KalayiniaS. TalebiS. MiryounesiM. SarkhailP. MahdiehN. An iranian congenital adrenal hypoplasia patient with elevated testosterone in infancy due to a novel pathogenic frameshift variant in NR0B1.Int. J. Endocrinol.202120211510.1155/2021/436702834938333
    [Google Scholar]
  24. BuonocoreF. AchermannJ.C. Primary adrenal insufficiency: New genetic causes and their long‐term consequences.Clin. Endocrinol.2020921112010.1111/cen.1410931610036
    [Google Scholar]
  25. ChoiH.S. KwonA. ChaeH.W. SuhJ. SongK.C. LeeJ.S. KimH.S. Identification of a novel point mutation in DAX-1 gene in a patient with adrenal hypoplasia congenita.Ann. Pediatr. Endocrinol. Metab.202126212612910.6065/apem.2040088.04434218634
    [Google Scholar]
  26. BertalanR. BencsikZ. MezeiP. VajdaZ. ButzH. PatócsA. Novel frameshift mutation of the NR0B1(DAX1) in two tall adult brothers.Mol. Biol. Rep.20194644599460410.1007/s11033‑019‑04688‑931280422
    [Google Scholar]
  27. SaengkaewT. PatelH.R. BanerjeeK. ButlerG. DattaniM.T. McGuiganM. StorrH.L. WillemsenR.H. DunkelL. HowardS.R. Genetic evaluation supports differential diagnosis in adolescent patients with delayed puberty.Eur. J. Endocrinol.2021185561762710.1530/EJE‑21‑038734403359
    [Google Scholar]
  28. RenaultC.H. AksglaedeL. WøjdemannD. HansenA.B. JensenR.B. JuulA. Minipuberty of human infancy – A window of opportunity to evaluate hypogonadism and differences of sex development?Ann. Pediatr. Endocrinol. Metab.2020252849110.6065/apem.2040094.04732615687
    [Google Scholar]
  29. MangueE-A.A. GuerraJ.G. HelenaV.L-M.S. SanchesG.M. NitschM.T. X-linked congenital adrenal hypoplasia: A clinical case report and description of a new complex rearrangement in the NR0B1 gene.IMPE Abstracts202396
    [Google Scholar]
  30. NagelS.A. HartmannM.F. RiepeF.G. WudyS.A. WabitschM. Gonadotropin-and adrenocorticotropic hormone-independent precocious puberty of gonadal origin in a patient with adrenal hypoplasia congenita due to DAX1 gene mutation–a case report and review of the literature: implications for the pathomechanism.Horm. Res. Paediatr.201991533634510.1159/00049518930537713
    [Google Scholar]
  31. DomeniceS. LatronicoA.C. BritoV.N. ArnholdI.J.P. KokF. MendoncaB.B. Adrenocorticotropin-dependent precocious puberty of testicular origin in a boy with X-linked adrenal hypoplasia congenita due to a novel mutation in the DAX1 gene.J. Clin. Endocrinol. Metab.20018694068407110.1210/jcem.86.9.781611549627
    [Google Scholar]
  32. LalliE. BardoniB. ZazopoulosE. WurtzJ.M. StromT.M. MorasD. Sassone-CorsiP. A transcriptional silencing domain in DAX-1 whose mutation causes adrenal hypoplasia congenita.Mol. Endocrinol.199711131950196010.1210/mend.11.13.00389415399
    [Google Scholar]
/content/journals/emiddt/10.2174/0118715303285405240202092244
Loading
/content/journals/emiddt/10.2174/0118715303285405240202092244
Loading

Data & Media loading...

This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error
Please enter a valid_number test