Dizygotic pregnancy as a possible mechanism of fetal gestation with a biallel mutation in the CYP11A1 gene: clinical case description.

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Abstract

Abstract


One of the variants of congenital dysfunction of the adrenal cortex is a deficiency of the enzyme P450scc, which catalyzes the first stage of steroidogenesis. This is a rare autosomal recessive disease, the classic manifestation of which is primary adrenal insufficiency with a deficiency of gluco-and mineralocorticoids and a violation of the synthesis of sex steroids, which usually leads to a complete lack of masculinization in patients with karyotype 46, XY and hypergonadotropic hypogonadism in both sexes. Previously, it was suggested That p450scc deficiency is incompatible with the normal course of pregnancy, since the enzyme is expressed in the placenta, where it is necessary for the synthesis of progesterone, the main pregnancy hormone, and, consequently, the birth of a child with A p450scc deficiency is impossible. However, the literature describes clinical cases of p450scc deficiency with partially preserved enzyme function, which explains the normal course of pregnancy. Whereas cases of confirmed p450scc deficiency with zero enzyme activity are unique, not being explained until now. We present a description of severe p450scc deficiency in a child born from a dizygotic twin pregnancy in which the second Sib was healthy. It is possible that the preserved hormonal function of the second placenta and (or) treatment with progesterone analogs during gestation contributed to gestation in this rare form of steroidogenesis disorder.


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About the authors

Yulia V. Kasyanova

Endocrinology Research Center, Moscow, Russia

Author for correspondence.
Email: yulia839@yandex.ru
ORCID iD: 0000-0002-2974-667X
SPIN-code: 9335-9841

Russian Federation, 11 Dm Ulyanova street, 117036 Moscow, Russia

MD

N Yu Kalinchenko

Endocrinology Research Centre

Email: kalinnat@rambler.ru
ORCID iD: 0000-0002-2000-7694
SPIN-code: 6727-9653

Russian Federation, 11, Dm. Ulyanova street, Moscow, 117036

MD, PhD

Anatoly N. Tiulpakov

Endocrinology Research Centre

Email: anatolytiulpakov@gmail.com
ORCID iD: 0000-0001-8500-4841
SPIN-code: 8396-1798

Russian Federation, 11 Dm. Ulyanova street, 117036 Moscow

MD, phD

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Copyright (c) Kasyanova Y.V., Kalinchenko N.Y., Tiulpakov A.N.

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