• PMID: 29178636
• Gene Name: CYP11A1
• Condition: Congenital adrenal insufficiency, Hypospadias
• Association: Associated
• Mutation: c.425+1G>A, p.E314K
• Population size: 1
• Population details: 1 case
• Age: 12 yr
• Sex: Male
• Infertility type: Male infertility

A novel splice site variant in CYP11A1 in trans with the p.E314K variant in a male patient with congenital adrenal insufficiency

Lara-Velazquez M, Perdomo-Pantoja A, Blackburn PR, Gass JM, Caulfield TR, Atwal PS.

BACKGROUND: The CYP11A1 gene encodes the cytochrome P450 side-chain cleavage enzyme, which is essential for steroid formation. Recessive variants in this gene can lead to impairment of sexual differentiation caused by a complete or partial loss of steroid hormone production. The phenotypic spectrum in affected 46XY males may vary from surgically repairable defects including cryptorchidism and hypospadias to complete feminization of external gonads, accompanied by symptoms of adrenal dysfunction. METHODS: Whole-exome sequencing (WES) of a 12-year-old male proband and his parents was performed after a protracted diagnostic odyssey failed to uncover the cause of his primary adrenal insufficiency. Of note, the proband had early symptomatology and corrective surgery for hypospadias, raising suspicion for a disorder of steroidogenesis. RESULTS: WES identified compound heterozygous variants in CYP11A1 including a novel canonical splice site variant (c.425+1G>A) and a previously reported p.E314K variant, which were consistent with a diagnosis of congenital adrenal insufficiency with partial 46XY sex reversal. CONCLUSION: Congenital adrenal insufficiency with 46XY sex reversal is a rare disorder that is characterized by dysregulation of steroid hormone synthesis, leading to adrenal and gonadal dysfunction. In this report, we describe a patient with adrenal insufficiency, hypospadias, and skin hyperpigmentation who was found to have a novel c.425+1G>A variant in trans with the p.E314K variant in CYP11A1. We performed structural analyses to examine the effect of the p.E314K variant on protein function and show that it falls in the core of the protein may disrupt cholesterol binding in the active site. CI - © 2017 The Authors. Molecular Genetics & Genomic Medicine published by Wiley Periodicals, Inc. FAU - Lara-Velazquez, Montserrat AU - Lara-Velazquez M AD - Department of Neurosurgery, Mayo Clinic, Jacksonville, Florida. FAU - Perdomo-Pantoja, Alexander AU - Perdomo-Pantoja A AD - Department of Neurosurgery, Johns Hopkins University, Baltimore, Maryland. FAU - Blackburn, Patrick R AU - Blackburn PR AUID- ORCID: 0000-0003-0658-1275 AD - Center for Individualized Medicine, Mayo Clinic, Jacksonville, Florida. AD - Department of Health Sciences Research, Mayo Clinic, Jacksonville, Florida. FAU - Gass, Jennifer M AU - Gass JM AUID- ORCID: 0000-0001-8189-4189 AD - Center for Individualized Medicine, Mayo Clinic, Jacksonville, Florida. FAU - Caulfield, Thomas R AU - Caulfield TR AD - Department of Neuroscience, Mayo Clinic, Jacksonville, Florida.