Pregnanetriol in the Range of 1.2-2.1 mg/m²/day as an Index of Optimal Control in CYP21A2 Deficiency

Abstract

Auxological data is the gold standard index of the therapeutic condition in CYP21A2 deficiency over a long-range period, whereas urinary pregnanetriol for 24 h (PT) is variable for a shorter-range period. Ideal PT levels in comparison with auxological data have not been reported. The main purpose of this study was to analyze ideal PT values as an index of optimal control for CYP21A2 deficiency. First, inter-daily fluctuation of PT was analyzed in one participant. PT levels were distributed over a wide range of 0.44-14.7 mg/day (n=42) in this participant, suggesting that the therapeutic condition should be judged by multiple PT samples. Second, the therapeutic periods of 15 participants with CYP21A2 deficiency were classified using auxological data and Cushing-like symptoms, and the PT levels were analyzed in each period retrospectively. The 95% confidence intervals for the means of the PT levels in the excessive, good and poor control periods were 0.03-1.25 (n=26), 1.23-2.09 (n=116), and 5.35-8.37 (n=72) mg/m²/day, respectively. In conclusion, 1.2-2.1 mg/m²/day of PT values can be used as an index of optimal control in CYP21A2 deficiency.