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ORIGINAL ARTICLE
Year : 2013  |  Volume : 17  |  Issue : 1  |  Page : 121-127

Brain magnetic resonance imaging findings in adult patients with congenital adrenal hyperplasia: Increased frequency of white matter impairment and temporal lobe structures dysgenesis


1 Department of Endocrinology, HediChaker Hospital, 3029 Sfax, Tunisia
2 Department of Radiology, HediChaker Hospital, 3029 Sfax, Tunisia
3 Department of Endocrinology and Internal Medicine, Tahar Sfar Hospital, 5111 Mahdia, Tunisia
4 Department of Pediatric, Tahar Sfar Hospital, 5111 Mahdia, Tunisia
5 Department of Pediatric, Hedi Chaker Hospital, 3029 Sfax, Tunisia

Correspondence Address:
Mahdi Kamoun
Endocrinology Department, Hedi Chaker Hospital, Magida Boulila Avenue, 3029 Sfax
Tunisia
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2230-8210.107833

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Background: Congenital adrenal hyperplasia (CAH) is an inherited recessive disorder of adrenal steroidogenesis. The enzymes most commonly affected are 21-hydroxylase. Past reports suggested brain magnetic resonance imaging (MRI) abnormalities in CAH patients, affecting white matter signal, temporal lobe and amygdala structure and function. Aims: In the present study, we aimed to investigate the frequency of white matter changes and temporal lobes structures dysgenesis in a population of patients having CAH due to 21-hydroxylase deficiency. Materials and Methods: Neurological examination and brain MRI were performed in 26 patients. Results: Neurological examination revealed mental retardation in three patients, tremor in two patients, tendon reflexes asymmetry in one patient, and cerebellar syndrome in one patient. Eleven patients (42.3%) showed MRI abnormalities: Eight of them had white matter hyperintensities, one patient had moderate atrophy in the right temporal, and hippocampal dysgenesis was found in the remaining two patients. Conclusions: Brain MRI abnormalities in CAH patients include white matter hyperintensities and temporal lobe structures dysgenesis. The mechanisms involved seem related to hormonal imbalances during brain development and exposure to excess exogenous glucocorticoids. Clinical implications of such lesions remain unclear. More extensive studies are required to define better the relationships between brain involvement and different CAH phenotypes and treatment regimens.


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