| Autor: |
Castro PS; Department of Pediatrics, Faculdade de Medicina, Hospital das Clinicas, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Minas Gerais, Brazil., Rassi TO; Department of Pediatrics, Faculdade de Medicina, Hospital das Clinicas, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Minas Gerais, Brazil., Araujo RF; Department of Pediatrics, Faculdade de Medicina, Hospital das Clinicas, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Minas Gerais, Brazil., Pezzuti IL; Department of Pediatrics, Faculdade de Medicina, Hospital das Clinicas, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Minas Gerais, Brazil., Rodrigues AS; Laboratorio de Hormonios e Genetica Molecular-LIM 42, Disciplina de Endocrinologia, Hospital das Clinicas, Faculdade de Medicina, Universidade de Sao Paulo (USP), São Paulo, Brazil., Bachega TASS; Laboratorio de Hormonios e Genetica Molecular-LIM 42, Disciplina de Endocrinologia, Hospital das Clinicas, Faculdade de Medicina, Universidade de Sao Paulo (USP), São Paulo, Brazil., Silva IN; Department of Pediatrics, Faculdade de Medicina, Hospital das Clinicas, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Minas Gerais, Brazil. |
| Abstrakt: |
Background Early diagnosis after newborn screening (NBS) for congenital adrenal hyperplasia (CAH) allows proper treatment, reducing mortality rates and preventing development of hyperandrogenic manifestations and incorrect sex assignment at birth. Despite the high NBS sensitivity to detect CAH classical forms, one of the main issues is identifying asymptomatic children who remained with increased 17-hydroxyprogesterone (17-OHP) levels. In this study, we aimed to contribute to understanding the diagnosis of these children. Methods Children with increased serum 17-OHP levels, and without disease-related clinical features during follow-up, underwent the entire CYP21A2 gene sequencing and multiplex ligation-dependent probe amplification (MLPA) analysis (SALSA MLPA P050B CAH). Patients' genotypes were subsequently sorted as compatible with CAH disease, and children were evaluated to determine the clinical status. Results During the study period, 106,476 newborns underwent CAH NBS. During follow-up, 328 children (0.3%) were identified as having false-positive tests and 295 were discharged after presenting with 17-OHP levels within reference values. Thirty-three remained asymptomatic and with increased serum 17-OHP levels after a mean follow-up of 3.4 years, and were subjected to molecular analysis. Seventeen out of the 33 children carried mutations: seven in the heterozygous state, nine carried non-classical genotypes and the remaining child carried a classical genotype. Conclusions We found a high frequency of non-classical CAH (NCCAH) diagnosis among children with persistent elevation of 17-OHP levels. Our findings support molecular study as decisive for elucidating diagnosis in these asymptomatic children. Molecular analysis as a confirmatory test is relevant to guide their follow-up, allows genetic counseling and avoids over treating NCCAH form. |
