Non-classical lipoid adrenal hyperplasia presenting as hypoglycemic seizures

Introduction Primary adrenal insufficiency is a potentially life-threatening condition that can have many underlying causes. Mutations in the steroidogenic acute regulatory protein (StAR) gene produce lipoid congenital adrenal hyperplasia (LCAH) which usually presents in the infantile period with severe symptoms of adrenal insufficiency. Less commonly, a non-classical form is identified which may present at a later age in affected individuals. Till date, around 30 individuals with the non-classical form have been described. Case presentation We describe a 4-year-old 46, XX Indian girl who presented with hypoglycemic seizures and was subsequently diagnosed as non-classical LCAH on genetic analysis, with homozygous R188C mutation in the StAR gene. Conclusions StAR mutations may have a variety of clinical presentations and are likely under-diagnosed. Genetic diagnosis is important for treatment as well as monitoring of reproductive function.

Keywords: R188C mutation; StAR mutation; congenital adrenal hyperplasia; hypoglycemic seizures; lipoid congenital adrenal hyperplasia; non-classical lipoid congenital adrenal hyperplasia; primary adrenal insufficiency; steroidogenic acute regulatory protein.