• Journal of mucopolysaccharidosis and rare diseases
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• 제3권1호
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• pp.28-32
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• 2017

Lipoid congenital adrenal hyperplasia (LCAH) is the severe form of congenital adrenal hyperplasia and is characterized by adrenal insufficiency with hyperpigmentation and female external genitalia irrespective of genetic sex. The steroidogenic acute regulatory protein (StAR) is required for the transport of cholesterol into the mitochondria for steroidogenesis, and defects in the StAR gene account for the majority of LCAH cases. In this report, we present a two-day-old hyperpigmented infant with phenotypical female genitalia. With consideration of the clinical and laboratory findings, the infant was suspected of having adrenal insufficiency due to LCAH and treated with glucocorticoid, mineralocorticoid, and sodium chloride. Karyotyping revealed 46, XY. Upon pelvis ultrasonography, adrenal hyperplasia with abdominal masses (thought to be the testicles) was reported. Molecular analysis with targeted exome sequencing revealed the homozygote mutation of c.772C>T ($p.Q258^*$) in exon 7 of the StAR gene. The early detection and treatment of adrenal insufficiency in infants with hyperpigmentation can prevent clinically apparent adrenal crises. During follow-up, the patient had a good clinical condition and maintained normal electrolyte and adrenocorticotropic hormone levels with medication.

• Clinical and Experimental Pediatrics
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• 제50권3호
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• pp.302-305
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• 2007

최근 해상도가 항진된 방사선학적 검사가 널리 사용되면서, 21-수산화효소 결핍증에 의한 선천성 부신 피질 과형성증 환아에서 부신피질종양이 발견되는 경우가 많아지고 있다. 일반적으로 적절한 스테로이드 호르몬 치료를 받은 21-수산화효소 결핍증 소아에서 부신피질 종양의 발생률는 매우 드물다. 저자들은 생후 초기부터 적절한 용량의 스테로이드 치료로 잘 조절되고 있는 염분소실형 21-수산화효소 결핍증을 가진 12세 여아에서 부신 종양이 우연히 발견된 1례를 보고하고자 한다.

• Clinical and Experimental Pediatrics
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• 제51권9호
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• pp.1018-1022
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• 2008

선천 부신 과다형성 환자에서 고환 부신 잔류 종양은 흔하게 발생한다. 대개 이 종양은 적절한 corticosteroid 억제 치료로 호전될 수 있다. 저자들은 양측성 고환 부신 잔류 종양을 보인 21-hydroxylase 결핍증 환아에게서 corticosteroid를 투여하였으나 반응하지 않아 고환 적출술을 시행한 사례를 경험하였기에 보고하는 바이다.

• Clinical and Experimental Pediatrics
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• 제60권2호
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• pp.31-37
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• 2017

Steroid 21-hydroxylase deficiency is the most prevalent form of congenital adrenal hyperplasia (CAH), accounting for approximately 95% of cases. With the advent of newborn screening and hormone replacement therapy, most children with CAH survive into adulthood. Adolescents and adults with CAH experience a number of complications, including short stature, obesity, infertility, tumor, osteoporosis, and reduced quality of life. Transition from pediatric to adult care and management of long-term complications are challenging for both patients and health-care providers. Psychosocial issues frequently affect adherence to glucocorticoid treatment. Therefore, the safe transition of adolescents to adult care requires regular follow-up of patients by a multidisciplinary team including pediatric and adult endocrinologists. The major goals for management of adults with 21-hydroxylase deficiency are to minimize the long-term complications of glucocorticoid therapy, reduce hyperandrogenism, prevent adrenal or testicular adrenal rest tumors, maintain fertility, and improve quality of life. Optimized medical or surgical treatment strategies should be developed through coordinated care, both during transition periods and throughout patients' lifetimes. This review will summarize current knowledge on the management of adults with CAH, and suggested appropriate approaches to the transition from pediatric to adult care.

• Clinical and Experimental Pediatrics
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• 제54권3호
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• pp.137-140
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• 2011

Testicular adrenal rest tumors (TARTs) are considered to be formed from aberrant adrenal tissue that has become hyperplastic because of elevated adrenocorticotropic hormone (ACTH) in male patients with congenital adrenal hyperplasia (CAH). A 6-year-old boy presented with testicular enlargement and pubic hair. He was diagnosed with CAH complicated by precocious puberty. However, he was not followed-up. At the age of 17, he visited the outpatient clinic because of testicular enlargement and short stature. His right and left testicles were $10{\times}6$ cm and $7.5{\times}4.5$ cm, respectively. His height was 155.1 cm (standard deviation score (SDS), -2.90). The diagnosis of CAH due to 21 hydroxylase deficiency was confirmed by mutation analysis of CYP21A2. Histological examination of the testes showed large, polygonal, eosinophilic cells with round nuclei and prominent nucleoli, which were suggestive of TARTs. He was treated with dexamethasone for 3 weeks and tumors regressed. Subsequently, dexamethasone was replaced by prednisolone and $9{\alpha}$-fludrocortisone; thereafter, the reduced testis size has been maintained.

• Journal of Genetic Medicine
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• 제5권2호
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• pp.111-118
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• 2008

목 적: 신생아 선별검사는 선천성 대사이상 질환을 조기에 진단하여 심각한 발달 지연이나 급성 질환, 심지어는 사망을 예방할 수 있어 점차 확산되고 있다. 본 연구에서는 우리나라에서 신생아 선별검사에 들어가는 비용과 시행하지 않을 때의 비용을 서로 비교하여 경제성 여부를 알아보고자 하였다. 대상 및 방법: 2005년 1월부터 2007년 12월까지 국내에서 단풍당뇨증, 호모시스틴뇨증, 갈락토스혈증 및 선천성 부신과형성증에 대한 신생아 선별검사를 받은 1,259,220명의 신생아를 대상으로 신생아 선별검사를 시행한 경우와 시행하지 않은 경우에 들어가는 비용을 비교하여 단풍당뇨증, 호모시스틴뇨증, 갈락토스혈증 및 선천성 부신과형성증에 대한 신생아 선별검사의 경제성 여부를 알아보고자 하였다. 결 과: 각 질환별로 신생아 선별 검사를 시행할 때와 시행하지 않을 때의 비용의 비를 분석해보면 단풍당뇨증이 1:0.5, 호모시스틴뇨증이 1:0.6로 낮은 유병률로 인해 검사를 시행하는 것이 손해였으며, 갈락토스혈증이 1:4.1, 선천성 부신과형성증이 1:2.9로 이득을 보여 전체적으로는 신생아 선별검사를 시행했을 때 총 2.0배의 이득이 있었다. 결 론: 단풍당뇨증, 호모시스틴뇨증, 갈락토스혈증, 선천성 부신과형성증에 대한 신생아 선별검사는 경제적 효용성 뿐만 아니라 개인의 삶의 질 향상을 위해서도 시행해야 하며 앞으로 윌슨병 등의 다른 유전성 대사질환에 대해서도 신생아 선별검사 시행을 고려해야 할 것이다.

• Mass Spectrometry Letters
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• 제2권3호
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• pp.69-72
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• 2011

Defective synthesis of the steroid hormones by the adrenal cortex has profound effects on human development and homeostasis. Due to the time-consuming chromatography procedure combined with mass spectrometry, the matrix-assisted laser desorption ionization method coupled to the linear ion-trap tandem mass spectrometry (MALDI-LTQ-MS/MS) was developed for quantitative analysis of 10 adrenal steroids in human serum. Although MALDI-MS can be introduced for its applicability as a high-throughput screening method, it has a limitation on reproducibility within and between samples, which renders poor reproducibility for quantification. For quantitative MALDI-MS/MS analysis, the stable-isotope labeled internal standards were used and the conditions of crystallization were tested. The precision and accuracy were 3.1~35.5% and 83.8~138.5%, respectively, when a mixture of 10 mg/mL ${\alpha}$-cyano-4-hydroxycinnamic acid in 0.2% TFA of 70% acetonitrile was used as the MALDI matrix. The limit of quantification ranged from 5 to 340 ng/mL, and the linearity as a correlation coefficient was higher than 0.988 for all analytes in the calibration range. Clinical applications include quantitative analyses of patients with congenital adrenal hyperplasia. The devised MALDI-MS/MS technique could be successfully applied to diagnosis of clinical samples.

• Clinical and Experimental Pediatrics
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• 제57권10호
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• pp.425-433
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• 2014

Adrenal and thyroid hormones are essential for the regulation of intrauterine homeostasis, and for the timely differentiation and maturation of fetal organs. These hormones play complex roles during fetal life, and are believed to underlie the cellular communication that coordinates maternal-fetal interactions. They serve to modulate the functional adaptation for extrauterine life during the perinatal period. The pathophysiology of systemic vasopressor-resistant hypotension is associated with low levels of circulating cortisol, a result of immaturity of hypothalamic-pituitary-adrenal axis in preterm infants under stress. Over the past few decades, studies in preterm infants have shown abnormal clinical findings that suggest adrenal or thyroid dysfunction, yet the criteria used to diagnose adrenal insufficiency in preterm infants continue to be arbitrary. In addition, although hypothyroidism is frequently observed in extremely low gestational age infants, the benefits of thyroid hormone replacement therapy remain controversial. Screening methods for congenital hypothyroidism or congenital adrenal hyperplasia in the preterm neonate are inconclusive. Thus, further understanding of fetal and perinatal adrenal and thyroid function will provide an insight into the management of adrenal and thyroid function in the preterm infant.

• Journal of Genetic Medicine
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• 제14권1호
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• pp.27-30
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• 2017

Adrenal hypoplasia congenita (AHC) is a rare cause of adrenal insufficiency during neonatal period. Mutations in the gene coding for DAX1 cause X-linked adrenal hypoplasia. Most affected patients are shown to have salt wasting and hyperpigmentation on the skin during the neonatal period and require intensive medical care. In addition, it is usually associated with hypogonadotropic hypogonadism in adolescence. The DAX1 gene is expressed in the adrenal cortex, pituitary gland, hypothalamus, testis, and ovary. We report on a patient with genetically confirmed AHC whose initial clinical presentations were consistent with congenital adrenal hyperplasia. A point mutation in the DAX1 gene identified in this report resulted in a truncated DAX1 protein. Our patient was diagnosed with AHC.

• Clinical and Experimental Pediatrics
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• 제46권4호
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• pp.400-403
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• 2003

진단이 지연되었거나 적절하게 치료되지 않은 선천성 부신 과형성증을 가진 남아에서 장기간 고농도의 남성호르몬에 노출될 경우 처음에는 가성 성조숙증이었다가 이후 진성 성조숙증으로 전환될 수 있으므로 선천성 부신 과형성증의 조기진단과 치료가 필요하다. 저자들은 가성 성조숙증에서 진성 성조숙증으로 전환된 선천성 부신 과형성증을 가진 남아에서 hydrocortisone과 GnRH 유도체를 사용하여 큰 부작용 없이 2차 성징의 퇴축을 가져온 1례를 경험하고 문헌고찰과 함께 보고하는 바이다.