21-Hydroxylase deficiency in Brazil

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1 Brazilian Journal of Medical and Biological Research (2000) 33: OH deficiency in Brazil ISSN X Hydroxylase deficiency in Brazil T.A.S.S. Bachega 1, A.E.C. Billerbeck 1, G. Madureira 1, J.A.M. Marcondes 1, C.A. Longui 2, M.V. Leite 3, I.J.P. Arnhold 1 and B.B. Mendonça 1 1 Unidade de Endocrinologia do Desenvolvimento e Laboratório de Hormônios e Genética Molecular, Disciplina de Endocrinologia, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil 2 Serviço de Endocrinologia Pediátrica, Departamento de Pediatria, Santa Casa, São Paulo, SP, Brasil 3 Departamento de Clínica Médica I, Universidade Federal do Rio Grande do Norte, Natal, RN, Brasil Correspondence B.B. Mendonça Divisão de Endocrinologia Hospital das Clínicas, FM, USP Caixa Postal São Paulo, SP Brasil Fax: beremen@usp.br Presented at the First International Meeting on Adrenal Disease: Basic and Clinical Aspects, Ribeirão Preto, SP, Brazil, August 31-September 2, Research partially supported by FAPESP (No. 95/8325-6) and CNPq (No /93-9). T.A.S.S. Bachega was supported by a grant from FAPESP (No. 98/ ). Received December 20, 1999 Accepted March 29, 2000 Key words 21-Hydroxylase deficiency Congenital adrenal hyperplasia Brazilian patients CYP21 mutations Genotype Phenotype Introduction

2 1212 T.A.S.S. Bachega et al. Patients and Methods Patients Hormone assays Molecular studies Southern blotting studies

3 21OH deficiency in Brazil 1213 Genotype categories Statistical analysis Results and Discussion

4 1214 T.A.S.S. Bachega et al.

5 21OH deficiency in Brazil 1215 References 1. New MI, White PC, Pang S, Dupont B & Speiser PW (1989). The adrenal hyperplasias. In: Scriver CR, Beaudet AL, Sly S & Valle D (Editors), The Metabolic Basis of Inherited Disease. McGraw-Hill Inc., New York, Morel Y & Miller WL (1991). Clinical and molecular genetics of congenital adrenal hyperplasia due to 21-hydroxylase deficiency. In: Harris H & Hirschhorn K (Editors), Advance of Human Genetics. Vol. 20. Plenum Press, New York, Carroll MC, Campbell RD & Porter RR (1985). Mapping of steroid 21-hydroxylase genes adjacent to complement component C4 genes in HLA, the major histocompatibility complex in man. Proceedings of the National Academy of Sciences, USA, 82: White PC, New MI & Dupont B (1986). Structure of human steroid 21-hydroxylase genes. Proceedings of the National Academy of Sciences, USA, 83: Higashi Y, Yoshioka H, Yamane M, Gotoh O & Fujii-Kuriyama Y (1986). Complete nucleotide sequence of two steroid 21- hydroxylase genes tandemly arranged in human chromosome: a pseudogene and a genuine gene. Proceedings of the Na-

6 1216 T.A.S.S. Bachega et al. tional Academy of Sciences, USA, 83: Higashi Y, Tanae A, Inoue H & Fujii- Kuriyama Y (1988). Evidence for frequent gene conversions in the steroid 21-hydroxylase (P-450c21) gene: implications for steroid 21-hydroxylase deficiency. A- merican Journal of Human Genetics, 42: New MI, Lorenzen F, Lerner AJ, Kohn B, Oberfield SE, Pollack MS, Dupont B, Stoner E, Levy DJ, Pang S & Levine LS (1983). Genotyping steroid 21-hydroxylase deficiency: hormonal reference data. Journal of Clinical Endocrinology and Metabolism, 57: Abraham G (1974). Radioimmunoassay of steroids in biological materials. Acta Endocrinologica, 75: Southern EM (1975). Detection of specific sequences among DNA fragments separated by gel electrophoresis. Journal of Molecular Biology, 98: Wilson RC, Wei JQ, Cheng KC, Mercado AB & New MI (1995). Rapid deoxyribonucleic acid analysis by allele-specific polymerase chain reaction for detection of mutations in the steroid 21-hydroxylase gene. Journal of Clinical Endocrinology and Metabolism, 80: Wedell A & Luthman H (1993). Steroid 21-hydroxylase deficiency: two additional mutations in salt wasting disease and rapid screening of disease-causing mutations. Human Molecular Genetics, 2: Speiser PW, Dupont J, Zhu D, Serrat J, Buegeleisen M, Tusié-Luna MT, Lesser M, New MI & White PC (1992). Disease expression and molecular genotype in congenital adrenal hyperplasia due to 21- hydroxylase deficiency. Journal of Clinical Investigation, 90: Rumsby G, Carroll MC, Porter RR, Grant DB & Hjelm M (1986). Deletion of the steroid 21-hydroxylase and complement C4 genes in congenital adrenal hyperplasia. Journal of Medical Genetics, 23: Mornet E, Crété P, Kuttenn F, Raux- Demay M-C, Boué J, White PC & Boué A (1991). Distribution of deletions and seven point mutations on CYP21 genes in three clinical forms of steroid 21-hydroxylase deficiency. American Journal of Human Genetics, 48: Morel Y, Murena M, Nicolino M & Forest MG (1992). Molecular genetics of the congenital adrenal hyperplasia due to 21-hydroxylase deficiency. In: Saez JM, Brownie AC, Capponi A, Chambaz EM & Mantero F (Editors), Cellular and Molecular Biology of the Adrenal Cortex. Vol Colloque INSERM/John Libbey Eurotext Ltd., France, Araujo M, Sanches MR, Suzuki LA, Guerra Jr G, Farah SB & Mello MP (1996). Molecular analysis of CYP21 and C4 genes in Brazilian families with the classical form of steroid 21-hydroxylase deficiency. Brazilian Journal of Medical and Biological Research, 29: Dardis A, Bergada I, Bergada C, Rivarola M & Belgorosky A (1997). Mutations of the steroid 21-hydroxylase gene in an Argentinean population of 36 patients with classical congenital adrenal hyperplasia. Journal of Pediatric Endocrinology and Metabolism, 10: Tusié-Luna MT, Ramírez-Jiménez S, Ordóñez-Sanchez ML, Cabello-Villegas J, Altamirano-Bustamante N, Calzada-León R, Robles-Valdés C, Mendoza-Morfín F, Méndez JP & Terán-García M (1996). Low frequency of deletion alleles in patients with steroid 21-hydroxylase deficiency in a Mexican population. Human Genetics, 98: Bachega TASS, Billerbeck AEC, Madureira G, Arnhold IJP, Medeiros MA, Marcondes JAM, Longui CA, Nicolau W, Bloise W & Mendonça BB (1999). Low frequency of CYP21 deletions in Brazilian patients with congenital adrenal hyperplasia due to 21- hydroxylase deficiency. Human Heredity, 49: Wedell A, Thilén A, Ritzén EM & Stengler B (1994). Mutational spectrum of the steroid 21-hydroxylase gene in Sweden: implications for genetic diagnosis and association with disease manifestation. Journal of Clinical Endocrinology and Metabolism, 78: Ordoñez-Sánchez ML, Ramírez-Jiménez S, López-Gutierrez AU, Riba L, Gamboa- Cardiel S, Cerrillo-Hinojosa M, Altamirano- Bustamante N, Calzada-Léon R, Robles- Valdés C, Mendonza-Morfín F & Tusié- Luna MT (1998). Molecular genetic analysis of patients carrying steroid 21-hydroxylase deficiency in the Mexican population: identification of possible new mutations and high prevalence of apparent germline mutations. Human Genetics, 102: Jääskeläinen J, Levo A, Voutilainen R & Partanen J (1997). Population-wide evaluation of disease manifestation in relation to molecular genotype in steroid 21-hydroxylase (CYP21) deficiency: good correlation in a well defined population. Journal of Clinical Endocrinology and Metabolism, 82: Bachega TASS, Billerbeck AEC, Madureira G, Marcondes JAM, Longui CA, Leite MV, Arnhold IJP & Mendonça BB (1998). Molecular genotype in Brazilian patients with classical and nonclassical forms of 21-hydroxylase deficiency. Journal of Clinical Endocrinology and Metabolism, 83: Carrera P, Bordone L, Azzani T, Brunelli V, Garancini MP, Chiumello G & Ferrari M (1996). Point mutations in Italian patients with classic, non-classic, and cryptic forms of steroid 21-hydroxylase deficiency. Human Genetics, 98: Ezquieta B, Oliver A, Gracia R & Gancedo PG (1995). Analysis of steroid 21-hydroxylase gene mutations in the Spanish population. Human Genetics, 96: Helmberg A, Tusié-Luna MT, Tabarelli M, Kofler R & White PC (1992). R339H and P453S: CYP21 mutations associated with nonclassic steroid 21-hydroxylase deficiency that are not apparent gene conversions. Molecular Endocrinology, 6: Bachega TASS, Billerbeck AEC, Marcondes JAM, Madureira G, Arnhold IJP & Mendonça BB (2000). Influence of different genotypes on 17-hydroxyprogesterone levels in patients with nonclassical congenital adrenal hyperplasia due to 21- hydroxylase deficiency. Clinical Endocrinology (in press). 28. Billerbeck AEC, Bachega TASS, Frazzatto ET, Nishi MY, Goldberg AC, Marin MLC, Madureira G, Monte O, Arnhold IJP & Mendonça BB (1999). A novel missense mutation Gly424Ser in Brazilian patients with 21-hydroxylase deficiency. Journal of Clinical Endocrinology and Metabolism, 84:

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