Pubertal and adult testicular functions in nonclassic lipoid congenital adrenal hyperplasia: A case series and review

Tomohiro Ishii, Naoaki Hori, Naoko Amano, Misaki Aya, Hirotaka Shibata, Noriyuki Katsumata, Tomonobu Hasegawa

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13 Citations (Scopus)


Lipoid congenital adrenal hyperplasia (LCAH) is caused by mutations in STAR and characterized by a defect in steroidogenesis and lipid droplet accumulation in steroidogenic cells. Patients with 46,XY and classic LCAH will typically present with female-type external genitalia. However, those with nonclassic LCAH will have masculinized external genitalia. The rarity of the nonclassic form has precluded the clarification of the long-term outcomes of testicular function in nonclassic LCAH. We report the cases of three adult males with nonclassic LCAH in whom primary adrenal insufficiency had been diagnosed at 5 days, 4 years, and 5 years of age. All exhibited complete male external genitalia and had completed pubertal development without androgen replacement. The endocrinological data showed preserved gonadal function in patients 1 and 2 and hypergonadotropic hypogonadism in patient 3. Semen analyses showed normozoospermia in patient 1 and mild oligozoospermia in patient 2. Electron microscopic analysis of a testicular biopsy specimen from patient 2 at 13 years of age revealed prominent lipid accumulation in the cytosol of Leydig cells. Patients 1 and 2 shared the same compound heterozygous mutations in STAR (p.Glu258∗ and p.Arg272Cys). Patient 3 possessed a heterozygous dominant-negative mutation in STAR (p.Gly22-Leu59del). A functional assay of a variant STAR-Arg272Cys determined the residual activity as 35% of the wild-type STAR. The results from the present case series and a review of four previously reported adult cases indicate that testosterone synthesis can be preserved in mostmales with nonclassic LCAH to complete pubertal development and induce germcellmaturation despite lipid accumulation in the Leydig cells.

Original languageEnglish
Pages (from-to)1367-1374
Number of pages8
JournalJournal of the Endocrine Society
Issue number7
Publication statusPublished - 2019 Jul


  • Lipoid congenital adrenal hyperplasia
  • Nonclassic form
  • Spermatogenesis
  • Steroidogenic acute regulatory protein
  • Testicular function

ASJC Scopus subject areas

  • Endocrinology, Diabetes and Metabolism


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