Turner syndrome with positive SRY gene and non-classical congenital adrenal hyperplasia: A case report

Abstract

Background: Co-morbidity of SRY gene turner syndrome (TS) with positive SRY gene and non-classical congenital adrenal hyperplasia (NCAH) is extremely rare and has never been reported to date.

Case summary: In this article, we present a 14-year-old girl who was referred to our hospital with short stature (weight of 43 kg and height of 143 cm, < -2 SD) with no secondary sexual characteristics (labia minora dysplasia). Laboratory tests indicated hypergonadotropic hypogonadism with significantly increased androstenedione and 17-hydroxyprogesterone (17-OHP) levels. This was accompanied by the thickening of the extremity of the left adrenal medial limb. The patient's karyotype was 45,X/46,X, +mar, and cytogenetic analysis using multiplex ligation-dependent probe amplification and high-throughput sequencing indicated that the SRY gene was positive with compound heterozygous mutations in CYP21A2 as the causative gene for congenital adrenal hyperplasia. The sites of the suspected candidate mutations were amplified and verified using Sanger sequencing. The patient was finally diagnosed as having SRY positive TS with NCAH. The patient and her family initially refused medical treatment. At her most recent follow-up visit (age = 15 years old), the patient presented facial hair, height increase to 148 cm, and weight of 52 kg, while androstenedione and 17-OHP levels remained high. The patient was finally willing to take small doses of hydrocortisone (10 mg/d).

Conclusion: In conclusion, upon evaluation of the patient mentioned in the report, we feel that 17-OHP measurement and cytogenetic analysis are necessary for TS patients even in the absence of significant virilization signs. This will play a significant role in guiding diagnosis and treatment.

Keywords: Case report; Congenital adrenal hyperplasia; Diagnosis; Endocrinology and metabolism; SRY gene; Tumor; Turner syndrome.

Figure 1

Computed tomography scan and Karyotype analysis indicated 45,X/46,X, +mar, and mosaicism with suspected Y chromosome material. A-D: Magnetic resonance imaging showed no uterus or ovary; E: Computed tomography of the adrenal gland indicated left adrenal hyperplasia; F: The patient’s karyotype is 45,X/46,X, +mar.

Figure 2

The sequences of the patients and her parents. A, C, and E: The patient’s sequence; B and D: The sequence of the patient's father; F: The sequence of the patient's mother.