J Clin Res Pediatr Endocrinol. Ahead of Print: JCRPE-85057 | DOI: 10.4274/jcrpe.galenos.2021.2021.0174

Rare Coexistence of Congenital Adrenal Hyperplasia due to 21-Hydroxylase Deficiency and Turner Syndrome: A Case Report and Brief Literature Review

Isabel Inácio¹, Joana Serra-caetano², Rita Cardoso², Isabel Dinis², Alice Mirante^2
1Endocrinology Department, Centro Hospitalar do Baixo Vouga, Aveiro, Portugal
²Department of Paediatric Endocrinology, Diabetes and Growth, Hospital Pediátrico de Coimbra, Coimbra, Portugal

Coexistence of congenital adrenal hyperplasia (CAH) due to 21-hydroxylase deficiency and Turner Syndrome (TS) is rare. We report a 6-year-old Portuguese girl with mosaic TS [45,XO(39)/47,XXX(21)] presented with premature pubarche at the age of 5 years. Laboratory findings showed elevated 17-hydroxyprogesterone, dehydroepiandrosterone sulfate, androstenedione and total testosterone, and sex-determining region Y (SRY) was negative. CYP21A2 gene analysis revealed two mutations (c.[844G>T]; [CYP21A2del]), consistent with the nonclassical
form of CAH. Complete deletion of CYP21A2 allele occurred de novo. At 6 years and 4 months, she presented accelerated growth velocity and hydrocortisone at the dose of 5 mg/m2/day was initiated. This case highlights the need to perform global examinations looking for virilization signs in TS patients follow-up. It also supports the reported genetic combination of TS and CAH. Therefore, CAH should be kept in mind in TS patients with SRY negative and virilization signs, even in the absence of short stature

Keywords: Adrenal hyperplasia, congenital, Turner syndrome, virilism, karyotyping

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