3?-hydroxysteroid dehydrogenase type II deficiency on newborn screening test / Deficiência de 3?-hidroxiesteroide desidrogenase tipo 2 em teste de triagem neonatal

3b-hydroxysteroid dehydrogenase II (3β-HSD) deficiency represents a rare CAH variant. Newborns affected with its classic form have salt wasting in early infancy and genital ambiguity in both sexes. High levels of 17-hydroxypregnenolone (Δ517OHP) are characteristic, but extra-adrenal conversion to 17-hydroxyprogesterone (17OHP) may lead to positive results on newborn screening tests. Filter paper 17OHP on newborn screening test was performed by immunofluorometric assay, and serum determinations of 17OHP and Δ517OHP, by radioimmunoassay. A 46,XY infant with genital ambiguity and adrenal crisis at three months of age presented a positive result on newborn screening for CAH. Serum determinations of 17OHP and Δ517OHP were elevated, and a high Δ517OHP/cortisol relation was compatible with the diagnosis of 3β-HSD deficiency. Molecular analysis of the HSD3B2 gene from the affected case revealed the presence of the homozygous p.P222Q mutation, whereas his parents were heterozygous for it. We present the first report of 3β-HSD type II deficiency genotype-proven detected at the Newborn Screening Program in Brazil. The case described herein corroborates the strong genotype-phenotype correlation associated with the HSD3B2 p.P222Q mutation, which leads to a classic salt-wasting 3β-HSD deficiency. Further evaluation of 17OHP assays used in newborn screening tests would aid in determining their reproducibility, as well as the potential significance of moderately elevated 17OHP levels as an early indicator to the diagnosis of other forms of classic CAH, beyond 21-hydroxylase deficiency.

A deficiência da enzima 3β-hidroxiesteroide desidrogenase tipo 2 (3β-HSD) representa variante rara de hiperplasia adrenal congenital (HAC). Recém-nascidos afetados com a forma clássica apresentam perda de sal nas primeiras semanas de vida e ambiguidade genital em ambos os sexos. Concentrações elevadas de 17-hidroxipregnenolona (Δ517OHP) são características, porém sua conversão extra-adrenal a 17-hidroxiprogesterona (17OHP) pode resultar em resultados positivos no teste de triagem neonatal. A determinação da concentração de 17OHP obtida em amostra de sangue colhida em papel-filtro para triagem neonatal foi realizada por ensaio imunofluorimétrico, e as concentrações séricas de 17OHP and Δ517OHP, por radioimunoensaio. Um menino, 46,XY, com ambiguidade genital e crise adrenal aos 3 meses de vida, apresentou teste positivo na triagem neonatal para HAC. As concentrações séricas de 17OHP e Δ517OHP estavam aumentadas, bem como a relação Δ517OHP/cortisol, o que foi compatível com o diagnóstico de deficiência de 3β-HSD. A análise molecular do gene HSD3B2 revelou a mutação p.P222Q em homozigose na criança afetada e em heterozigose em seus pais, o que confirmou a deficiência de 3β-HSD com resultado moderadamente elevado na dosagem de 17OHP no “Teste do Pezinho” (Programa de Triagem Neonatal do Distrito Federal, Brasil). Esse caso corrobora a forte correlação genótipo-fenótipo associada à mutação p.P222Q no gene HSD3B2. Estudos futuros para avaliação dos ensaios utilizados na triagem neonatal para determinação de 17OHP poderão auxiliar na determinação do significado potencial de concentrações moderadamente elevadas de 17OHP como um indicador precoce para o diagnóstico de outras formas de HAC clássicas, além da deficiência de 21-hidroxilase.

A novel homozygous mutation p.E25X in the HSD3B2 gene causing salt wasting 3β-hydroxysteroid dehydrogenases deficiency in a Chinese pubertal girl: a delayed diagnosis until recurrent ovary cysts / 中华儿科杂志

<p><b>OBJECTIVE</b>3β- hydroxysteroid dehydrogenase deficiency (3βHSD), a rare form of congenital adrenal hyperplasia (CAH) resulted from mutations in the HSD3B2 gene that impair steroidogenesis in both adrenals and gonads. We report clinical features and the results of HSD3B2 gene analysis of a Chinese pubertal girl with salt wasting 3βHSD deficiency.</p><p><b>METHOD</b>We retrospectively reviewed clinical presentations and steroid profiles of the patient diagnosed in Guangzhou Women and Children's Medical Center in 2013. PCR and direct sequencing were used to identify any mutation in the HSD3B2 gene.</p><p><b>RESULT</b>A 13-year-old girl was diagnosed as CAH after birth because of salt-wasting with mild clitorimegaly and then was treated with glucocorticoid replacement. Breast and pubic hair development were normal, and menarche occurred at 12 yr, followed by menstrual bleeding about every 45 days. In the last one year laparoscopic operation and ovariocentesis were performed one after another for recurrent ovary cysts. Under corticoid acetate therapy, ACTH 17.10 pmol/L (normal 0-10.12), testosterone 1.31 nmol/L (normal <0.7), dehydroepiandrosterone sulfate 13.30 µmol/L (normal 0.95 - 11.67), cortisol 720 nmol/L (normal 130-772.8), androstenedione, 17-hydroxyprogesterone and progesterone were normal. Estradiol 461 pmol/L, follicle-stimulating hormone 3.04 IU/L, luteinizing hormone 8.52 IU/L in follicular phase. A pelvic ultrasound showed lateral ovaries cysts (58 mm × 50 mm × 35 mm) and a midcycle-type endometrium. A novel nonsense mutation c.73G >T (p.E25X) was identified in HSD3B2 gene. The girl was homozygous and her mother was heterozygous, while her father was not identified with this mutation.</p><p><b>CONCLUSION</b>A classic 3βHSD deficiency is characterized by salt wasting and mild virilization in female. Ovary cysts may be the one of features of gonad phenotype indicating ovary 3βHSD deficiency. A novel homozygous mutation c.73G >T(p.E25X) was related to the classical phenotype.</p>

Culture of bovine ovarian follicle wall sections maintained the highly estrogenic profile under basal and chemically defined conditions

Follicle cultures reproduce in vitro the functional features observed in vivo. In a search for an ideal model, we cultured bovine antral follicle wall sections (FWS) in a serum-free defined medium (DM) known to induce 17β-estradiol (E2) production, and in a nondefined medium (NDM) containing serum. Follicles were sectioned and cultured in NDM or DM for 24 or 48 h. Morphological features were determined by light microscopy. Gene expression of steroidogenic enzymes and follicle-stimulating hormone (FSH) receptor were determined by RT-PCR; progesterone (P4) and E2 concentrations in the media were measured by radioimmunoassay. DM, but not NDM, maintained an FWS morphology in vitro that was similar to fresh tissue. DM also induced an increase in the expression of all steroidogenic enzymes, except FSH receptor, but NDM did not. In both DM and NDM, there was a gradual increase in P4 throughout the culture period; however, P4 concentration was significantly higher in NDM. In both media, E2 concentration was increased at 24 h, followed by a decrease at 48 h. The E2:P4 ratio was higher in DM than in NDM. These results suggest that DM maintains morphological structure, upregulates the expression of steroidogenic enzyme genes, and maintains steroid production with a high E2:P4 ratio in FWS cultures.

Structural aspects of the p.P222Q homozygous mutation of HSD3B2 gene in a patient with congenital adrenal hyperplasia / Aspectos estruturais da mutação homozigótica p.P222Q do gene HSD3B2 em um paciente com hiperplasia congênita da adrenal

Type II 3β-hydroxysteroid dehydrogenase/Δ5-Δ4-isomerase (3β-HSD2), encoded by the HSD3B2 gene, is a key enzyme involved in the biosynthesis of all the classes of steroid hormones. Deleterious mutations in the HSD3B2 gene cause the classical deficiency of 3β-HSD2, which is a rare autosomal recessive disease that leads to congenital adrenal hyperplasia (CAH). CAH is the most frequent cause of ambiguous genitalia and adrenal insufficiency in newborn infants with variable degrees of salt losing. Here we report the molecular and structural analysis of the HSD3B2 gene in a 46,XY child, who was born from consanguineous parents, and presented with ambiguous genitalia and salt losing. The patient carries a homozygous nucleotide c.665C>A change in exon 4 that putatively substitutes the proline at codon 222 for glutamine. Molecular homology modeling of normal and mutant 3β-HSD2 enzymes emphasizes codon 222 as an important residue for the folding pattern of the enzyme and validates a suitable model for analysis of new mutations.

A enzima 3β-hydroxysteroid dehydrogenase/Δ5-Δ4-isomerase do tipo 2 (3β-HSD2), codificada pelo gene HSD3B2, é importante na biossíntese de todas as classes de hormônios esteroides. As mutações no gene HSD3B2 podem causar deficiência da 3β-HSD2 da forma clássica. É de herança autossômica recessiva e uma das causas mais raras de hiperplasia congênita da adrenal (HCA). A deficiência dessa enzima leva frequentemente à ambiguidade genital e à insuficiência da adrenal em recém-nascidos com vários níveis de perda de sal. Neste trabalho, foi feito o estudo estrutural e molecular do gene HSD3B2 gene em um paciente 46,XY, filho de pais consanguíneos, com ambiguidade genital e perda de sal. O paciente é homozigoto para a troca nucleotídica c.665C>A no éxon 4, que putativamente leva à substituição de uma prolina do códon 222 por uma glutamina. A modelagem molecular por homologia das enzimas 3β-HSD2 normal e mutantes ressaltou que a prolina no códon 222 é um resíduo importante no enovelamento da enzima e validou um modelo adequado para avaliações de novas mutações.

Expression of 3b-Hydroxysteroid dehydrogenase and P450 side chain cleavage enzyme in the human uterine endometrium

The enzyme complex 3b-hydroxysteroid dehydrogenase/delta(5)-delta(4)-isomerase (3beta-HSD) is involved in the biosynthesis of all classes of active steroids. The expression of 3beta-HSD in human uterine endometrium during the menstrual cycle and decidua was examined in an effort to understand its role during ova implantation. 3beta-HSD was weakly expressed in the glandular epithelium of the proliferative phase and moderately expressed in the glandular epithelium of secretory phase of the endometrium. In the decidua of the ectopic pregnancy, 3beta-HSD was strongly expressed. The human uterine endometrial 3beta-HSD was identified as being the same type as the placental 3beta-HSD by RT-PCR and sequence analysis. In addition to the expression of 3beta-HSD, P450scc was expressed in the decidua of the ectopic pregnancy. These results suggest that pregnenolone might be synthesized from cholesterol by P450scc de novo and then, it is converted to progesterone by 3beta-HSD in the uterine endometrium. The data implies that the endometrial 3beta-HSD can use not only the out-coming pregnenolone from the adrenal gland but also the self- made pregnenolone to produce progesterone. The de novo synthesis of progesterone in the endometrium might be a crucial factor for implantation and maintenance of pregnancy.

Late onset adrenal hyperplasia due to 3 beta-hydroxy-delta 5-steroid dehydrogenase deficiency in north Indian hirsute women.

The presence of late onset 3 beta-hydroxy steroid dehydrogenase (3 beta-HSD) type of congenital adrenal hyperplasia was studied in 58 north Indian hirsute women. The age range of these patients was 15 to 42 yr. Fifty two per cent of these patients had body mass index > 25. Basal serum testosterone, luteinizing hormone, follicle stimulating hormone, dehydroepiandrosterone sulphate (DHEAS), and 17 hydroxy progesterone (17 OHP) were estimated. All the patients underwent adrenocorticotropin (ACTH) stimulation test after an overnight dexamethasone suppression for the estimation of DHEAS, 17 OHP, and 17 hydroxy pregnenolone (delta 5-17p). Five (8.6%) hirsute women showed an exaggerated 17 OHP response to ACTH indicating 21-hydroxylase deficiency. Eight (13.8%) hirsute women had elevated basal DHEAS and ACTH-stimulated DHEAS as well as delta 5-17P responses indicative of 3 beta-HSD deficiency. In one patient hirsutism was the presenting manifestation of tumoural hyperandrogenism. Our findings indicate the presence of both 21-hydroxylase and 3 beta-HSD deficiency in north Indian hirsute women, with, 3 beta-HSD deficiency being the major cause of hirsutism in this population.

Effect of lithium chloride on testicular delta 5-3 beta, 17 beta-hydroxy steroid dehydrogenase, acid phosphatase and gametogenesis in Bufo melanostictus.

Injection of lithium chloride at the dose of 200 micrograms/toad/alternate day for 7, 14 and 21 days caused a significant reduction in the activities of testicular delta 5-3 beta, 17 beta-hydroxysteroid dehydrogenase and acid phosphatase enzymes. There was a marked inhibition in spermatogenesis in lithium chloride treated toad for 14 and 21 days of treatment, but 7 days of treatment has no effect.

Patología de los tumores inducidos por progestágenos / Pathology of the tumors induced by progestagens

El objetivo de este trabajo es describir las lesiones preneoplásicas y neoplásicas inducidas en la glándula mamaria de ratones hembra vírgenes de la cepa BALB/c inoculados con medroxiprogesterona (MPA) y progesterona (Pg). La MPA induce adenocarcinomas mamarios ductales con una incidencia actuarial del 79 por ciento y una latencia media de 52ñ2 semanas. Estos tumores son precedidos por lesiones preneoplásicas de los conductos que se caracterizan por hiperplasia ductal sólida o papilar y progresiva evolución hacia el carcinoma in situ. La progesterona induce adenocarcinomas lobulillares con una incidencia actuarial del 28 por ciento y una latencia de aparición de 46ñ13 semanas. En los tratados con Pg se observaron hiperplasias de los brotes terminales con eventual diferenciación en estructuras alveolares similares a las de una mama lactante. En etapas posteriores el epitelio alveolar se hiperplasia y aparecen los primeros signos de displasia; existe aumento en el nómero de las estructuras lobulillares hiperplásicas y displasias y ocasional secresión focal en algunos lobulillos. Las hiperplasias atípicas y carcinomas "in situ" se caracterizan por un aumento del nómero de estructuras alveolares, acompañado por hiperplasia progresiva del epitelio de revestimiento, que rellena estas estructuras. Los carcinomas infiltrantes se caracterizan por formar grupos sólidos o estructuras lobulares compuestas por células atípicas redondas o poligonales, de citoplasma claro y con un alto índice mitótico. Los tumores infiltran extensamente el estroma adyacente y muestran, ocasionalmente, diferenciación tubular o alveolar.

Progesterone, its A/B cis reduction and delta aminolevulinic acid synthetase in the developing hen

La 5 ß reductasa (Rasa) aumenta después de la eclosión en tejidos esteroidogénicos de la gallina en desarrollo, especialmente en el ovario derecho. La sintetasa del ácido delta aminolevulínico (ALAs) es más activa en estos tejidos que en hígado durante la mayoría de los estadios embrionarios. Pero después de la eclosión sólo aumenta en forma aguda ALAs hepática y adrenal; en ovario izquierdo dicha enzima crece moderadamente y en ovario derecho desciende a valores muy bajos. Cierta relación entre las curvas de ALAs y Rasa durante el desarrollo embrionario del ovario izquierdo y la adrenal sugieren que la 5 ß pregnanediona fuera un inductor natural de la ALAs en estas glándulas endocrinas funcionantes, por lo menos durante sus estadios embrionarios