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An update to 21-hydroxylase deficient congenital adrenal hyperplasia 

Authors: Eftihios Trakakis a;  George Basios a;  Pantelis Trompoukis a;  George Labos a;  Ioannis Grammatikakis a; Demetrios Kassanos a
Affiliation:   a Third Department of Obstetrics and Gynecology, University of Athens, Attikon University Hospital, Athens, Greece
DOI: 10.1080/09513590903015494
Publication Frequency: 12 issues per year
First Published on: 03 June 2009
Formats available: HTML (English) : PDF (English)
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Abstract

Congenital adrenal hyperplasia (CAH) due to deficiency of the enzyme 21-hydroxylase (21-OH) is distinguished in classical (C-CAH) and non-classical form (NC-CAH), and it is also one of the most common autosomal recessive inherited disorders in humans. The prevalence of C-CAH is between 1:10,000 and 1:15,000 among the live neonates of North America and Europe while the NC-CAH occurs in approximately 0.2% of the general white population. The highest incidence of CAH (1:282 and 1:2141, respectively) has been evaluated in Yupik Eskimos in Alaska and in the populations of the island La Reunion (France), while the lower was detected in New Zealand newborns (0.3%). Nowadays, it has been established that except for the adrenal cortex in CAH cases, the adrenal medulla was also affected. In human 21-OH deficient adrenal gland it has been discovered that not only the chromaffin cells formed extensive neurites, expanding between adrenocortical cells, but also that the adrenal androgens promote outgrowth, whereas glucocorticoids preserve neuroendocrine cells. It seems that normal cortisol secretion by the adrenal cortex is necessary for adrenomedullary organogenesis. The synthesis of 21-OH is controlled by the active CYP21A2 gene located at a distance of 30 kb from a highly homologous pseudogene designated CYP21A1P.
Keywords: Congenital adrenal hyperplasia; genetics; pathophysiology
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