Congenital adrenal hyperplasia due to 21-hydroxylase deficiency: Newborn screening and its relationship to the diagnosis and treatment of the disorder

Songya Pang, Anastasia Clark, Eurico Camargo Neto, Roberto Giugliani, Heather Dean, Jeremy Winter, Jean Louis Dhondt, J. P. Farriaux, Annette Graters, Emanuele Cacciari, Antonio Balsamo, Sandro Piazzi, Seizo Suwa, Yusuhiro Kuroda, Yoshiro Wada, Hiroshi Naruse, T. Kizaki, N. Ichihara, Osamu Arai, S. HaradaKenji Fujieda, Nobuo Matsuura, Seizo Suwa, Satoshi Kusuda, Masaru Fukushi, Yoshikiyo Mizushima, Y. Kikuti, Takio Yoyoura, Sumitaka Saisho, Kazukiko Shimozawa, Masaru Matsumoto, Dianne Webster, Laura Vilarinho, A. M. Wallace, Iñaki Eguileor, I. Marzana, Elena Dulin Iñiguez, A. Fernandez Sanchez, C. Gonzalez Gallego, Lars Hagenfeldt, Claes Guthenberg, Ulrika von Dobeln, Astrid Thilen, Agne Larsson, T. Torresani, Christy LeBlond, Christine Papadea, Frank Rumph, Willie Craft, Sydney Kling, Eva Tsalikian, Jennifer Cook, J. Getchell, J. Susanin, Marvin Mitchell, Lindsay Hofman, Edwin Naylor, Bradford Therrell, Lois Brown, Linda Prentice, Michael Glass, Sheila Neier

Research output: Contribution to journalReview article

132 Scopus citations

Abstract

Congenital adrenal hyperplasia (CAH) due to 21-hydroxylase deficiency can be detected by newborn screening. The screening alone in 29 programs from 13 countries resulted in the diagnosis of CAH in 1 2 of affected newborns and expedited the diagnosis in 1 3 of affected newborns clinically suspected to have CAH. The benefits of newborn screening for CAH were prevention of severe adrenal crisis, its sequela, incorrect male sex assignment of severely virilized female newborns, and progressive signs of androgen excess. Screening revealed a higher incidence of CAH worldwide (1:15000 live births) compared with the case survey incidence (1:32000 live births) The false-positive rate (usually found in low birth weight and premature infants) was acceptably low (0.01-0.5%) except for three programs (0.7-2.5%). The false-negative rate of CAH screening was negligible. Prenatal diagnosis of CAH is possible by HLA typing or 21-hydroxylase B gene analysis of cultured fetal cells from chorionic villus biopsy sampling in the first trimester and from amniotic cells or hormonal analysis of amniotic fluid in the second trimester. Prenatal treatment of CAH is possible via maternal dexamethasone therapy beginning early pregnancy. However, efficacy and side effects of maternal dexamethasone therapy require further investigation.

Original languageEnglish (US)
Pages (from-to)105-139
Number of pages35
JournalScreening
Volume2
Issue number2-3
DOIs
StatePublished - 1993
Externally publishedYes

Keywords

  • 21-Hydroxylase deficiency
  • Adrenal cortical function
  • Congenital adrenal hyperplasia
  • Newborn screening

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health

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