21-羟化酶缺陷症伴肾上腺腺瘤及睾丸肾上腺残余肿瘤一例  

A case with 21-hydroxylase deficiency combined with adrenal adenoma and testicular adrenal rest tumors

作　　者：张曼娜[1] 孙首悦[1] 刘玥隽[1] 顾卫琼[1] 刘建民[1] 洪洁[1] 宁光[1] 李小英[1] 

机构地区：[1]上海交通大学医学院附属瑞金医院内分泌代谢病科,上海市内分泌代谢病临床医学中心,上海市内分泌代谢病研究所,200025

出　　处：《中华内分泌代谢杂志》2011年第4期315-319,共5页Chinese Journal of Endocrinology and Metabolism

基　　金：上海市科委基金资助项目（09DJ1400402）

摘　　要：目的 分析1例21-羟化酶缺陷症伴肾上腺腺瘤及睾丸肾上腺残余肿瘤患者的临床特点及分子遗传学诊断.方法 全面收集1例单纯男性化型21-羟化酶缺陷症患者的临床资料,对患者睾丸肿瘤组织进行病理活检,并采用PCR产物直接测序方法明确CYP21基因突变.结果 患者为中年男性,因＂右侧肾上腺皮质腺瘤术后,左侧肾上腺肿块＂入院;激素测定示：ACTH、孕酮、17-羟孕酮、雄烯二酮、睾酮明显高于正常值,CT示右侧肾上腺切除术后、左侧肾上腺弥漫性增生伴多发结节,精液常规未见精子.睾丸活检示：纤维组织增生伴玻璃样变和局灶钙化.基因测序检测到患者CYP21基因第2号内含子纯合突变.结论 未经诊治的21-羟化酶缺陷症患者可能伴发肾上腺腺瘤和（或）睾丸肾上腺残余肿瘤.Objective To investigate the clinical and genetic characteristics in a male patient with 21hydroxylase deficiency combined with adrenal and testicular tumors.Methods Clinical features and laboratory data were collected from the patient.Testicular biopsy was performed.The CYP21 gene was sequenced for mutations.Results The patient presented left adrenal and testicular enlargements.The laboratory examinations showed that plasma ACTH,androstenedione,testosterone,progesterone,and 17-hydroxyprogesterone were markedly elevated.CT scan revealed that the right adrenal gland being resected and the left adrenal with nodular enlargement.Furthermore,testicular biopsy showed a prominent peritubular fibrosis with increased number of peritubular fibroblasts,tubular hyalinisation,and calcification.Sequencing analysis showed a A〉G homozygous mutation at intron 2.Conclusion Patients with untreated 21-hydroxylage deficiency may.have adrenal adenomas and（or）testicular adrenal rest tumor simultaneously.

关 键 词：21-羟化酶缺陷症 睾丸肾上腺残余肿瘤 CYP21基因 基因突变 

分 类 号：R586[医药卫生—内分泌] R736.6[医药卫生—内科学]