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The specificity of progesterone as a marker of 21-hydroxylase deficiency, as opposed to deficiency of other enzymes involved in steroid pathways, is still not well studied. [ 184 ] [ 185 ] [ 186 ] Cortisol is one of the two main final products of 21-hydroxylase, and the deficiency of this enzyme may lead to a certain degree of cortisol deficiency.
In 21-hydroxylase deficiency, especially in mild cases (LOCAH), the androgen "backdoor" pathway [18] may be the reason of androgen excess. [54] This backdoor pathway is not always considered in the clinical evaluation of patients with hyperandrogenism conditions such as LOCAH and may be a source of diagnostic pitfalls and confusion. [55]
Genetic variants in the CYP21A2 gene cause a disturbance in the development of the enzyme, leading to congenital adrenal hyperplasia (CAH) due to 21-hydroxylase deficiency. Gene conversion events involving the functional gene and the pseudogene account for many cases of steroid 21-hydroxylase deficiency. [64] CAH is an autosomal recessive ...
As such, defects in the backdoor pathway from 17α-hydroxyprogesterone (17OHP) or progesterone (P4) to DHT lead to undervirilization in male fetuses because placental P4 is the precursor of DHT via the backdoor pathway. [12] In 21-hydroxylase deficiency [17] or cytochrome P450 oxidoreductase deficiency, [18] even a mild increase in circulating ...
21-deoxycortisol is a marker of congenital adrenal hyperplasia due to 21-hydroxylase deficiency, [2] [1] [3] even in mild (non-classic) cases. [4] [5] It can be also used for newborn screening. [6] The deficiency of the 21-hydroxylase enzyme leads to excess of 17α-hydroxyprogesterone, [7] [8] a 21-carbon (C 21) steroid.
In all its forms, congenital adrenal hyperplasia due to 21-hydroxylase deficiency accounts for about 95% of diagnosed cases of CAH. [2] Unless another specific enzyme is mentioned, "CAH" in nearly all contexts refers to 21-hydroxylase deficiency. (The terms "salt-wasting CAH", and "simple virilizing CAH" usually refer to subtypes of this ...
11β-Hydroxylase – corticosteroid synthesis; 17α-Hydroxylase – androgen and glucocorticoid synthesis; 18-Hydroxylase (aldosterone synthase) – mineralocorticoid synthesis; 21-Hydroxylase – corticosteroid synthesis; Cytochrome P450 (CYP1, 2, 3) – estrogen metabolism; Hydroxysteroid dehydrogenases (and ketosteroid reductases)
It has been known since 1987 that increased levels of 11β-OHP occur in 21-hydroxylase deficiency. [6] [7] A study in 2017 has shown that in subjects with 21-hydroxylase deficiency, serum 11β-OHP concentrations range from 0.012 to 3.37 ng/mL, while in control group it was below detection limit of 0.012 ng/mL.