The role for 11-oxygenated androgens in HPG-axis disturbances in congenital adrenal hyperplasia due to 21-hydroxylase deficiency [article]

Matthias K. Auer, Luisa Paizoni, Meike Neuner, Christian Lottspeich, Heinrich Schmidt, Martin Bidlingmaier, Brian Keevil, Nicole Reisch
2021 medRxiv   pre-print
Context Hypothalamus-pituitary-gonadal (HPG)-axis disturbances are a common phenomenon in patients with classic congenital adrenal hyperplasia (CAH). 11-oxygenated androgens have been suggested to play a role in this context. Design Cross-sectional single center study including 89 patients (N=42 men, N=55 women) with classic CAH. Main Outcome Measures Independent predictors for hypogonadism in men and secondary amenorrhea in women with CAH with a special focus on 11-ketotestosterone (11KT) and
more » ... 1β-hydroxyandrostenedione (11OHA4). Results Hypogonadotropic hypogonadism was present in 23% of men and 61% of those women currently not on contraceptives suffered from irregular menstrual cycles or amenorrhea. Testicular adrenal rest tumor (TART) was documented in 28% of men. While 11KT (3.5x) and 11OHA4 (5.7x) among other adrenal steroids were significantly elevated in men with hypogonadism, in stepwise logistic regression, the only significant independent predictor for hypogonadism were elevated 17-OHP levels (B = 0.006; p = 0.039). Although 11KT (5.2x) and 11OHA4 (3.7x) levels were also significantly higher in women with amenorrhea in comparison to those with a regular cycle, the only significant predictor for amenorrhea were elevated total testosterone levels (B = 1.806; p = 0.040). 11-oxygenated androgens were not different in those with TART and those without. Of note, there were no significant differences in 11OHA4 or 11KT between those with a regular cycle and those currently on hormonal contraceptives. Conclusions 11-oxygenated androgens do not seem to add additional information for explaining menstrual disturbances and hypogonadism in patients with CAH in comparison to established marker of disease control.
doi:10.1101/2021.01.13.21249718 fatcat:rounynnj5fgqrpalr2yxfp6aly