11-Oxygenated Androgens Are Biomarkers of Adrenal Volume and Testicular Adrenal Rest Tumors in 21-Hydroxylase Deficiency

• Published in: The journal of clinical endocrinology and metabolism Vol. 102; no. 8; pp. 2701 - 2710
• Main Authors: Turcu, Adina F, Mallappa, Ashwini, Elman, Meredith S, Avila, Nilo A, Marko, Jamie, Rao, Hamsini, Tsodikov, Alexander, Auchus, Richard J, Merke, Deborah P
• Format: Journal Article
• Language: English
• Published: Washington, DC Endocrine Society 01.08.2017; Oxford University Press
• Subjects: 17-alpha-Hydroxypregnenolone - analogs & derivatives; 17-alpha-Hydroxypregnenolone - metabolism; Adolescent; Adrenal Glands - pathology; Adrenal Hyperplasia, Congenital - metabolism; Adrenal Rest Tumor - metabolism; Adult; Age Determination by Skeleton; Aged; Androgens; Androgens - metabolism; Androstenedione - analogs & derivatives; Androstenedione - metabolism; Androstenes - metabolism; Bioindicators; Biomarkers; Bone tumors; Child; Child, Preschool; Children; Clinical s; Complications; Cortodoxone - metabolism; Cross-Sectional Studies; Disease control; Female; Females; Glucocorticoids; Hirsutism; Hirsutism - metabolism; Humans; Hydroxylase; Hydroxytestosterones - metabolism; Male; Males; Menstruation; Menstruation Disturbances - metabolism; Middle Aged; Organ Size; Oxygenated; Oxygenation; Pituitary; Pituitary hormones; Pregnenolone; Pregnenolone - metabolism; Pregnenolone sulfate; Spectrometry; Steroid hormones; Steroids; Sulfates; Testes; Testicular Neoplasms - metabolism; Testosterone; Testosterone - analogs & derivatives; Testosterone - metabolism; Tumors; Young Adult
• DOI: 10.1210/jc.2016-3989
• ISSN: 0021-972X

Abstract Context Patients with 21-hydroxylase deficiency (21OHD) have long-term complications, resulting from poor disease control and/or glucocorticoid overtreatment. Lack of optimal biomarkers has made it challenging to tailor therapy and predict long-term outcomes. Objective To identify biomarkers of disease control and long-term complications in 21OHD. Setting and Participants Cross-sectional study of 114 patients (70 males), ages 2 to 67 years (median, 15 years), seen in a tertiary referral center. Methods We correlated a mass-spectrometry panel of 23 steroids, obtained before first morning medication, with bone age advancement (children), adrenal volume (adults), testicular adrenal rest tumors (TART), hirsutism, menstrual disorders, and pituitary hormones. Results Total adrenal volume correlated positively with 18 steroids, most prominently 21-deoxycortisol and four 11-oxygenated-C19 (11oxC19) steroids: 11β-hydroxyandrostenedione (11OHA4), 11-ketoandrostenedione (11ketoA4), 11β-hydroxytestosterone (11OHT), and 11-ketotestosterone (11ketoT) (r ≈ 0.7, P < 0.0001). Nine steroids were significantly higher (P ≤ 0.01) in males with TART compared with those without TART, including 11OHA4 (6.8-fold), 11OHT (4.9-fold), 11ketoT (3.6-fold), 11ketoA4 (3.3-fold), and pregnenolone sulfate (PregS; 4.8-fold). PregS (28.5-fold) and 17-hydroxypregnenolone sulfate (19-fold) levels were higher (P < 0.01) in postpubertal females with menstrual disorders. In males, testosterone levels correlated positively with all 11oxC19 steroids in Tanner stages 1 and 2 (r ≈ 0.7; P < 0.001) but negatively in Tanner stage 5 (r = −0.3 and P < 0.05 for 11ketoA4 and 11ketoT). In females, testosterone level correlated positively with all four 11oxC19 steroids across all Tanner stages (r ≈ 0.8; P < 0.0001). Conclusion 11oxC19 steroids and PregS might serve as clinically useful biomarkers of disease control and long-term complications in 21OHD. Using LC-MS/MS, we show 11-oxygenated 19-carbon steroids and pregnenolone sulfate are biomarkers of disease control and long-term complications in adults and children with 21-hydroxylase deficiency.