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The effect of fetal androgen metabolism‐related gene variants on external genitalia virilization in congenital adrenal hyperplasia
Author(s) -
Kaupert LC,
LemosMarini SHV,
De Mello MP,
Moreira RP,
Brito VN,
Jorge AAL,
Longui CA,
Guerra G,
Mendonca BB,
Bachega TA
Publication year - 2013
Publication title -
clinical genetics
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.543
H-Index - 102
eISSN - 1399-0004
pISSN - 0009-9163
DOI - 10.1111/cge.12016
Subject(s) - virilization , congenital adrenal hyperplasia , genotype , sex organ , biology , androgen , medicine , endocrinology , phenotype , genetics , gene , hormone
The 21‐hydroxylase deficiency ( 21OHD ) is caused by CYP21A2 mutations resulting in severe or moderate enzymatic impairments. 21OHD females carrying similar genotypes present different degrees of external genitalia virilization, suggesting the influence of other genetic factors. Single nucleotide variants ( SNVs ) in the CYP3A7 gene and in its transcription factors, related to fetal 19‐carbon steroid metabolism, could modulate the genital phenotype. To evaluate the influence of the 21OHD genotypes and the CYP3A7 , PXR and CAR SNVs on the genital phenotype in 21OHD females. Prader scores were evaluated in 183 patients. The CYP3A7 , PXR and CAR SNVs were screened and the 21OHD genotypes were classified according to their severity: severe and moderate groups. Patients with severe genotype showed higher degree of genital virilization (Prader median III , IQR III‐IV ) than those with moderate genotype ( III , IQR II‐III ) (p < 0.001). However, a great overlap was observed between genotype groups. Among all the SNVs tested, only the CAR rs2307424 variant correlated with Prader scores ( r 2 = 0.253; p = 0.023). The CYP21A2 genotypes influence the severity of genital virilization in 21OHD females. We also suggest that the CAR variant, which results in a poor metabolizer phenotype, could account for a higher degree of external genitalia virilization.