A2 Refereed review article in a scientific journal

Near-miss apparent SIDS from adrenal crisis




AuthorsGassner HL, Toppari J, Quinteiro González S, Miller WL

Publication year2004

JournalJournal of Pediatrics

Journal name in sourceThe Journal of pediatrics

Journal acronymJ Pediatr

Volume145

Issue2

First page 178

Last page83

Number of pages6

ISSN0022-3476

DOIhttps://doi.org/10.1016/j.jpeds.2004.04.052


Abstract
Adrenal crisis from salt-losing congenital adrenal hyperplasia (CAH) typically occurs in the first 2 weeks of life. We evaluated 3 infants with adrenal crisis who presented at 6 to 8 months of age with near-miss sudden infant death syndrome (SIDS).\nThree 46,XY phenotypic female infants presented near death at 6 to 8 months of age with adrenal crisis and unmeasurable steroid hormones consistent with congenital lipoid adrenal hyperplasia (lipoid CAH).\nWe sequenced genes potentially causing this phenotype: steroidogenic acute regulatory protein (StAR), the cholesterol side-chain cleavage enzyme, adrenodoxin reductase, adrenodoxin, and steroidogenic factor 1 (SF1). Site-directed mutagenesis and functional assays were performed for the missense mutation.\nHormonal values showed complete absence of adrenal and gonadal steroids. Patient 1 was a compound heterozygote for missense mutation R140P and an mRNA splice donor site mutation in the StAR gene. The R140P mutation was wholly inactive in vitro. Patient 2 was homozygous for a 7 base pair StAR deletion causing a frameshift. No mutations were found in Patient 3, suggesting a novel disease.\nAlthough genetic disorders of steroidogenesis typically present in the first month of life, some defects, especially those in StAR, can present in mid-infancy, when adrenal hyperplasias are rarely considered. Adrenal insufficiency is a subtle disorder that may cause cardiovascular collapse, causing unexplained infant death that resembles SIDS.\nOBJECTIVE\nSUBJECTS\nMETHODS\nRESULTS\nCONCLUSIONS



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