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Steroid disorders in children: congenital adrenal hyperplasia and apparent mineralocorticoid excess.

Abstract
Our research team and laboratories have concentrated on two inherited endocrine disorders, congenital adrenal hyperplasia (CAH) and apparent mineralocorticoid excess, in thier investigations of the pathophysiology of adrenal steroid hormone disorders in children. CAH refers to a family of inherited disorders in which defects occur in one of the enzymatic steps required to synthesize cortisol from cholesterol in the adrenal gland. Because of the impaired cortisol secretion, adrenocorticotropic hormone levels rise due to impairment of a negative feedback system, which results in hyperplasia of the adrenal cortex. The majority of cases is due to 21-hydroxylase deficiency (21-OHD). Owing to the blocked enzymatic step, cortisol precursors accumulate in excess and are converted to potent androgens, which are secreted and cause in utero virilization of the affected female fetus genitalia in the classical form of CAH. A mild form of the 21-OHD, termed nonclassical 21-OHD, is the most common autosomal recessive disorder in humans, and occurs in 1/27 Ashkenazic Jews. Mutations in the CYP21 gene have been identified that cause both classical and nonclassical CAH. Apparent mineralocorticoid excess is a potentially fatal genetic disorder causing severe juvenile hypertension, pre- and postnatal growth failure, and low to undetectable levels of potassium, renin, and aldosterone. It is caused by autosomal recessive mutations in the HSD11B2 gene, which result in a deficiency of 11beta-hydroxysteroid dehydrogenase type 2. In 1998, we reported a mild form of this disease, which may represent an important cause of low-renin hypertension.
AuthorsM I New, R C Wilson
JournalProceedings of the National Academy of Sciences of the United States of America (Proc Natl Acad Sci U S A) Vol. 96 Issue 22 Pg. 12790-7 (Oct 26 1999) ISSN: 0027-8424 [Print] United States
PMID10536001 (Publication Type: Journal Article, Research Support, U.S. Gov't, P.H.S.)
Chemical References
  • Mineralocorticoids
  • Dexamethasone
  • Cytochrome P-450 Enzyme System
  • Steroid 21-Hydroxylase
Topics
  • Adrenal Hyperplasia, Congenital
  • Cytochrome P-450 Enzyme System (genetics)
  • Dexamethasone (therapeutic use)
  • Female
  • Genotype
  • Humans
  • Infant, Newborn
  • Male
  • Mineralocorticoids (metabolism)
  • Mutation
  • Neonatal Screening
  • Pedigree
  • Phenotype
  • Prenatal Diagnosis
  • Steroid 21-Hydroxylase

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