Classic and non-classic 21-hydroxylase deficiency can be discriminated from P450 oxidoreductase deficiency in Japanese infants by urinary steroid metabolites
Open accessAbstract
We previously reported a two-step biochemical diagnosis to discriminate classic 21-hydroxylase deficiency (C21OHD) from P450 oxidoreductase deficiency (PORD) by using urinary steroid metabolites: the pregnanetriolone/tetrahydrocortisone ratio (Ptl / the cortisol metabolites 5α- and 5β-tetrahydrocortisone (sum of these metabolites termed THEs), and 11β-hydroxyandrosterone (11OHAn). The objective of this study was to investigate whether both C21OHD and non-classic 21OHD (C+NC21OHD) could be biochemically differentiated from PORD. We recruited 55 infants with C21OHD, 8 with NC21OHD, 16 with PORD, 57 with transient hyper-17α-hydroxyprogesteronemia (TH17OHP), and 2,473 controls. All infants were Japanese with ages between 0-180 d. In addition to Ptl, THEs, and 11OHAn, we measured urinary tetrahydroaldosterone (THAldo) and pregnenediol (PD5). The first step: by Ptl with the age-specific cutoffs 0.06 mg/g creatinine (0-10 d of age) and 0.3 mg/g creatinine (11-180 d of age), we were able to differentiate C+NC21OHD and PORD from TH17OHP and controls (0-10 d of age: 0.065-31 vs. < 0.001-0.052, 11-180 d of age: 0.40-42 vs. < 0.001-0.086) with 100% sensitivity and specificity. The second step: by the 11OHAn/THAldo or 11OHAn/PD5 ratio with a cutoff of 0.80 or 1.0, we were able to discriminate between C+NC21OHD and PORD (1.0-720 vs. 0.021-0.61 or 1.8-160 vs. 0.005-0.32, respectively) with 100% sensitivity and specificity. Ptl, 11OHAn/THAldo, and 11OHAn/PD5 could differentiate between C+NC21OHD and PORD in Japanese infants.
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Adrenal enzyme defects show unique metabolic patterns (disease signatures, metabotypes).
“Adrenal enzyme defects show unique metabolic patterns (disease signatures, metabotypes) (293).”
From Congenital Adrenal Hyperplasia—Current Insights in Pathophysiology, Diagnostics, and Management (2022) · cites this paper as [293]
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High frequency of nonclassical steroid 21-hydroxylase deficiency
SPEISER, P. W., DUPONT, B. O., RUBINSTEIN, P., PIAZZA, A., KASTELAN, A., & NEW, M. I. (1986) · Obstetrical & Gynecological Survey · doi:10.1097/00006254-198604000-00017 · Cited by 523 · see citing works
Krone, N., Hughes, B. A., Lavery, G. G., Stewart, P. M., Arlt, W., & Shackleton, C. H. L. (2010) · The Journal of Steroid Biochemistry and Molecular Biology · doi:10.1016/j.jsbmb.2010.04.010 · Cited by 434 · see citing works
Therrell, B. L., Berenbaum, S. A., Manter-Kapanke, V., Simmank, J., Korman, K., Prentice, L., Gonzalez, J., & Gunn, S. (1998) · Pediatrics · doi:10.1542/peds.101.4.583 · Cited by 344 · see citing works
Huang, N., Pandey, A. V., Agrawal, V., Reardon, W., Lapunzina, P. D., Mowat, D., Jabs, E. W., Vliet, G. V., Sack, J., Flück, C. E., et al. (2005) · The American Journal of Human Genetics · doi:10.1086/429417 · Cited by 336 · see citing works
Nonclassical 21-Hydroxylase Deficiency
New, M. I. (2006) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jc.2006-1645 · Cited by 315 · see citing works
High frequency of nonclassical steroid 21-hydroxylase deficiency.
Speiser, P., Dupont, B., Rubinstein, P., Piazza, A., Kaštelan, A., & New, M. I. (1985) · PubMed · Cited by 265 · see citing works
Azziz, R., Hincapie, L. A., Knochenhauer, E. S., Dewailly, D., Fox, L., & Boots, L. R. (1999) · Fertility and Sterility · doi:10.1016/s0015-0282(99)00383-0 · Cited by 244 · see citing works
Lacey, J. M., Minutti, C. Z., Magera, M. J., Tauscher, A. L., Casetta, B., McCann, M., Lymp, J., Hahn, S. H., Rinaldo, P., & Matern, D. (2004) · Clinical Chemistry · doi:10.1373/clinchem.2003.027193 · Cited by 216 · cited 1× · see citing works
“Thus, this method is a potential option for scrutiny of newborn mass-screened positive patients together with liquid chromatography/ tandem mass spectrometry (17, 18) and genetic analysis (19, 20).”
MethodJanzen, N., Peter, M., Sander, S., Steuerwald, U., Terhardt, M., Holtkamp, U., & Sander, J. (2007) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jc.2006-2890 · Cited by 211 · see citing works
Fukami, M., Horikawa, R., Nagai, T., Tanaka, T., Naiki, Y., Sato, N., Okuyama, T., Nakai, H., Soneda, S., Tachibana, K., et al. (2005) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jc.2004-0810 · Cited by 155 · see citing works
Self-citationHomma, K., Hasegawa, T., Nagai, T., Adachi, M., Horikawa, R., Fujiwara, I., Tajima, T., Takeda, R., Fukami, M., & Ogata, T. (2006) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jc.2005-2460 · Cited by 153 · see citing works
Self-citationCaulfield, M. P., Lynn, T., Gottschalk, M. E., Jones, K. L., Taylor, N. F., Malunowicz, E. M., Shackleton, C. H. L., Reitz, R. E., & Fisher, D. A. (2002) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jcem.87.8.8712 · Cited by 120 · see citing works
Fukami, M., Nishimura, G., Homma, K., Nagai, T., Hanaki, K., Uematsu, A., Ishii, T., Numakura, C., Sawada, H., Nakacho, M., et al. (2009) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jc.2008-2816 · Cited by 117 · see citing works
Self-citationBiochemical diagnosis of Antley–Bixler syndrome by steroid analysis
Shackleton, C. H. L., Marcos, J., Małunowicz, E., Szarras‐Czapnik, M., Jira, P. E., Taylor, N., Murphy, N., Crushell, E., Gottschalk, M. E., Hauffa, B. P., et al. (2004) · American Journal of Medical Genetics Part A · doi:10.1002/ajmg.a.30104 · Cited by 86 · see citing works
Fukami, M., Hasegawa, T., Horikawa, R., Ohashi, T., Nishimura, G., Homma, K., & Ogata, T. (2006) · Pediatric Research · doi:10.1203/01.pdr.0000195825.31504.28 · Cited by 79 · see citing works
Self-citationHomma, K., Hasegawa, T., MASUMOTO, M., Takeshita, E., Watanabe, K., Chiba, H., Kurosawa, T., Takahashi, T., & Matsuo, N. (2003) · Endocrine Journal · doi:10.1507/endocrj.50.783 · Cited by 63 · see citing works
Self-citationGenetic variation in human P450 oxidoreductase
Miller, W. L., Huang, N., Agrawal, V., & Giacomini, K. M. (2009) · Molecular and Cellular Endocrinology · doi:10.1016/j.mce.2008.09.017 · Cited by 54 · see citing works
Kösel, S., Burggraf, S., Fingerhut, R., Dörr, H. G., Roscher, A. A., & Olgemöller, B. (2005) · Clinical Chemistry · doi:10.1373/clinchem.2004.042416 · Cited by 52 · see citing works
Homma, K., Hasegawa, T., Takeshita, E., Watanabe, K., Anzo, M., Toyoura, T., Jinno, K., Ohashi, T., Hamajima, T., Takahashi, Y., et al. (2004) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jc.2004-0473 · Cited by 37 · see citing works
Self-citationKoyama, Y., Homma, K., Fukami, M., Miwa, M., Ikeda, K., Ogata, T., Hasegawa, T., & Murata, M. (2012) · Clinical Chemistry · doi:10.1373/clinchem.2011.173286 · Cited by 30 · see citing works
Self-citationKashimada, K., Makoto, O. N. O., ONISHI, T., KOYAMA, S., Toyoura, T., Imai, K., Saisho, S., & Mizutani, S. (2008) · Endocrine Journal · doi:10.1507/endocrj.k07e-057 · Cited by 20 · see citing works
Kashimada, K., Ishii, T., Nagasaki, K., Ono, M., Tajima, T., Yokota, I., & Hasegawa, Y. (2015) · Endocrine Journal · doi:10.1507/endocrj.ej14-0377 · Cited by 16 · see citing works
Urinary steroid profiling: a powerful method for the diagnosis of abnormal steroidogenesis
Koyama, Y., Homma, K., & Hasegawa, T. (2014) · Expert Review of Endocrinology & Metabolism · doi:10.1586/17446651.2014.904199 · Cited by 9 · see citing works
Self-citationNordenström, A., Thilén, A., Hagenfeldt, L., Larsson, A., & Wedell, A. (1999) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jcem.84.5.5651 · Cited by 2 · see citing works
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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., et al. (2022) · Endocrine Reviews · doi:10.1210/endrev/bnab016 · Cited by 556 · see citing works
Clinical guidelines for the diagnosis and treatment of 21-hydroxylase deficiency (2021 revision)
Ishii, T., Kashimada, K., Amano, N., Takasawa, K., Nakamura‐Utsunomiya, A., Yatsuga, S., Mukai, T., Ida, S., Isobe, M., Fukushi, M., et al. (2022) · Clinical Pediatric Endocrinology · doi:10.1297/cpe.2022-0009 · Cited by 30 · see citing works
Zalas, D., Reinehr, T., Niedziela, M., Borzikowsky, C., Flader, M., Ŝimić-Schleicher, G., Akkurt, H. I., Heger, S., Hornig, N., Holterhus, P., et al. (2018) · Hormone Research in Paediatrics · doi:10.1159/000488028 · Cited by 12 · see citing works
Wang, C., & Tian, Q. (2023) · Frontiers in Endocrinology · doi:10.3389/fendo.2023.1226387 · Cited by 11 · see citing works
Congenital adrenal hyperplasia due to P450 oxidoreductase deficiency
Zhang, J., Woo, K. L., Hai, Y., Wang, S., Lin, Y., Huang, Y., Peng, X., Wu, H., Zhang, S., Yan, L., et al. (2022) · Frontiers in Endocrinology · doi:10.3389/fendo.2022.1020880 · Cited by 10 · see citing works
Turning the spotlight on the C11-oxy androgens in human fetal development
du Toit, T., & Swart, A. C. (2021) · The Journal of Steroid Biochemistry and Molecular Biology · doi:10.1016/j.jsbmb.2021.105946 · Cited by 10 · see citing works
Clinical characteristics of cytochrome P450 oxidoreductase deficiency: a nationwide survey in Japan
Yatsuga, S., Amano, N., Nakamura-Utsunomiya, A., Kobayashi, H., Takasawa, K., Nagasaki, K., Nakamura, A., Nishigaki, S., Numakura, C., Fujiwara, I., et al. (2020) · Endocrine Journal · doi:10.1507/endocrj.ej20-0011 · Cited by 9 · see citing works
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Luchetti, S., Mason, M. R. J., Lière, P., Pianos, A., Cossu, S., Hofstee, M. I., Sluiter, A. A., Adelia, van Scheppingen, J., Aronica, E., et al. (2025) · Neurobiology of Disease · doi:10.1016/j.nbd.2025.107040 · Cited by 2 · see citing works
Kawasaki, Y., Sato, T., Nakano, S., Usui, T., Narumi, S., Ishii, T., & Hasegawa, T. (2022) · Clinical Pediatric Endocrinology · doi:10.1297/cpe.2021-0066 · Cited by 1 · see citing works
Self-citationShimakawa, U., Shigehara, K., Kawabe, Y., Ouchi, K., & Mori, J. (2020) · Cureus · doi:10.7759/cureus.11763
Urine Steroid Profiles Using GC-MS
Nakagawa, T. (2022) · Journal of the Mass Spectrometry Society of Japan · doi:10.5702/massspec.s22-30
Honour, J. W. (2023) · Elsevier eBooks · doi:10.1016/b978-0-12-818124-9.00004-8
A Two-Step LC-MS/MS method to differentiate 21OHD and PORD in Screen-Positive newborns
Nakatani, H., Watanabe, K., Tsuji‐Hosokawa, A., Sutani, A., Saito, Y., Kirino, S., Yamano, H., Orimoto, R., Gau, M., Yogi, A., et al. (2026) · Endocrine · doi:10.1007/s12020-026-04573-z
Self-citation
- Authors
- Koyama, Y., Homma, K., Fukami, M., Miwa, M., Ikeda, K., Ogata, T., Murata, M., & Hasegawa, T.
- Affiliations
- LSI Medience Corporation (Japan) (JP)
- Keio University Hospital (JP)
- National Research Institute for Child Health and Development (JP)
- Keio University (JP)
- Hamamatsu University School of Medicine (JP)
- Venue
- Clinical Pediatric Endocrinology
- Published
- 2016
- Volume
- 25
- Issue
- 2
- Pages
- 37-44
- ISSN
- 0918-5739 (ISSN-L)
- 1347-7358
- PMC
- PMC4860514
- OpenAlex
- W2342402017
- Cited by
- 13
- References
- 25
- Citations by year
- 2026: 1 · 2025: 1 · 2023: 2 · 2022: 4 · 2021: 2 · 2020: 2 · 2018: 1
- FWCI
- 0.17
- Type
- journal article
- Language
- en
- Open access
- diamond
- doi.org
- Licence
- cc-by-nc-nd
- Locations
- Clinical Pediatric Endocrinology (publishedVersion, cc-by-nc-nd)
- PubMed Central (publishedVersion, cc-by-nc-nd)
- PubMed (publishedVersion)
- Funders
- Ministry of Health, Labour and Welfare
- University of Miyazaki
- Tokyo Medical and Dental University
- Topics
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Molecular Biology › Sexual Differentiation and Disorders
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Adrenal Hormones and Disorders
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Clinical Biochemistry › Metabolism and Genetic Disorders
- Keywords
- 21-hydroxylase deficiency, P450 oxidoreductase deficiency, congenital adrenal hyperplasia, urinary steroid metabolites, tetrahydrocortisone, tetrahydroaldosterone, differential diagnosis, infants, Japanese infants, diagnostic thresholds
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