Cited by 13Sexual Differentiation and DisordersAdrenal Hormones and DisordersMetabolism and Genetic Disorders

Classic and non-classic 21-hydroxylase deficiency can be discriminated from P450 oxidoreductase deficiency in Japanese infants by urinary steroid metabolites

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Koyama, Yuhei, Homma, Keiko, Fukami, Maki, Miwa, Masayuki, Ikeda, Kazushige, Ogata, Tsutomu, Murata, Mitsuru, Hasegawa, Tomonobu·2016·Clinical Pediatric Endocrinology

Abstract

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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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
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
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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