Side-chain cleavage enzyme deficiency: Systematic review and case series
Aditya Phadte1, Sneha Arya1, Vijaya Sarathi2
1Department of Endocrinology, Seth G S Medical College & KEM Hospital, Mumbai, India.
Clinical Endocrinology
|November 10, 2022
Summary
P450 side-chain cleavage deficiency (SCCD) in 46,XY individuals presents with distinct gonadal outcomes based on external genitalia presentation. Specific genotypes correlate with typical male genitalia and better pubertal development in SCCD patients.
Area of Science:
- Endocrinology
- Genetics
- Pediatric Endocrinology
Background:
- P450 side-chain cleavage deficiency (SCCD) causes primary adrenal insufficiency (PAI), with variable external genitalia in 46,XY individuals.
- The correlation between SCCD genotype and gonadal function, particularly in relation to external genitalia characteristics, remains poorly understood.
Approach:
- A retrospective review of three SCCD patients was conducted, alongside a systematic review of 52 genetically confirmed SCCD probands.
- Patients were categorized into SCCD with typical male external genitalia (SCCD-TMG) and SCCD with atypical external genitalia (SCCD-AG) based on the Sinnecker score.
Key Points:
- Age at PAI diagnosis and renin levels did not differ between SCCD-TMG and SCCD-AG groups.
- Spontaneous puberty, normal prepubertal and pubertal gonadotropins, and normal pubertal testosterone levels were significantly more common in SCCD-TMG.
- Testicular adrenal rest tumors were exclusively observed in the SCCD-TMG group. Four specific genotypes were associated with SCCD-TMG.
Conclusions:
- SCCD-TMG is characterized by four distinct genotypes and exhibits different gonadal characteristics compared to SCCD-AG.
- These findings highlight specific genotypic and phenotypic correlations in 46,XY SCCD patients, aiding in understanding disease variability.
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