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Normal male external genitalia do not rule out CYP11A1 deficiency
  1. Vijaya Sarathi1,2 and
  2. Chithambaram Nagalingam3
  1. 1 Endocrinology, Vydehi Institute of Medical Sciences and Research Centre, Bangalore, Karnataka, India
  2. 2 Endocrinology, Narayana Medical College and Hospital, Nellore, Andhra Pradesh, India
  3. 3 Paediatrics, Vydehi Institute of Medical Sciences and Research Centre, Bangalore, Karnataka, India
  1. Correspondence to Prof Vijaya Sarathi, drvijayasarathi{at}


Defects in the initial steps of steroidogenesis usually present with female external genitalia in both 46,XX and 46,XY. Hence, they are not often considered in the differential diagnosis of primary adrenal insufficiency children with normal male external genitalia. Here, we report a boy with normal male external genitalia who presented with hyperpigmentation since the age of 2 years but diagnosis was delayed till 11 years of age. Evaluation revealed low-serum cortisol with elevated adrenocorticotropic hormone and direct renin level confirming primary adrenal insufficiency. Clinical exome sequencing analysis revealed a homozygous c.1351C>T (p.R451W) mutation in exon 8 of the CYP11A1 gene which was confirmed on Sanger sequencing. Both parents were heterozygous for the variation. To conclude, we report the first case of CYP11A1 deficiency from India. The report reiterates the existence of non-classic CYP11A1 deficiency characterised by primary adrenal insufficiency and normal male external genitalia in 46,XY.

  • adrenal disorders
  • thyroid disease
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  • Contributors VS did the endocrine evaluation of the case and drafted the manuscript; CN did the initial evaluation of the patient and critically reviewed the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Patient consent for publication Parental/guardian consent obtained.

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