Is there an association between prostate-specific antigen and androgen levels in 46, XX patients with congenital adrenal hyperplasia?

• Published in: Journal of pediatric urology 2021-08, Vol.17 (4), p.481.e1-481.e7
• Main Authors: de Almeida, Rayanna Bahia, Apóstolos, Robson Augusto Cardoso, Oliveira, Luciana Mattos Barros, Toralles, Maria Betânia Pereira, Lago, Renata Maria R.S., Faria, José Antonio Diniz, Arruti, Renata Andion, Rodrigues, Mônica Lima Barbosa, Amorim, Tatiana, dos Santos, Helena Maria Guimarães Pimentel, de Sousa, Leonardo Azevedo, Barroso, Ubirajara
• Format: Article
• Language: English
• Subjects: 17-alpha-Hydroxyprogesterone; Adolescent; Adrenal Hyperplasia, Congenital - diagnosis; Androgen levels; Androgenization; Androgens; Child; Child, Preschool; Congenital adrenal hyperplasia (CAH); Female; Humans; Infant; Infant, Newborn; Male; Prostate-Specific Antigen; Prostate-specific antigen (PSA); Retrospective Studies; Young Adult
• ISSN: 1477-5131; 1873-4898
• DOI: 10.1016/j.jpurol.2021.05.003

Congenital adrenal hyperplasia (CAH), a genetic disease characterized by defective cortisol synthesis and excessive levels of sex hormones, can cause precocious puberty in both sexes in untreated individuals and virilization in female patients with a 46, XX karyotype. The female paraurethral (Skene's) gland has been reported as prostate analogous. Growth of prostate tissue is associated with androgen production; therefore, prostate-specific antigen (PSA) levels may represent a marker of virilization in 46, XX patients with CAH. To describe PSA levels in 46, XX patients and evaluate whether higher PSA levels are associated with androgenization and the severity of the disease. Sixty-six patients with CAH and a 46, XX karyotype were included, irrespective of age. Serum PSA, testosterone, 17-hydroxyprogesterone (17-OHP) and androstenedione levels were measured. Patients’ age, age at diagnosis, forms of the disease, Prader classification, bone age assessment, sex of rearing, surgery, and the presence of clinical complications were obtained from their medical records. The mean age of patients was 11.45 ± 10.74 years. Forty-three patients (65%) were diagnosed neonatally at a median of 0.08 years (mean 1.47 ± 2.34 years), with registers of 17-OHP measurements (Guthrie test) being available in 51%. Testosterone, 17-OHP and androstenedione were significantly high. PSA was detectable in 25% of cases (levels >0.01 ng/ml), with a mean of 0.03 ± 0.09 ng/ml, and only in patients over five years of age. A correlation was found between PSA and age (p