P450 oxidoreductase deficiency: a new form of congenital adrenal hyperplasia

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Purpose of review

P450 oxidoreductase deficiency – a newly described form of congenital adrenal hyperplasia – typically presents a steroid profile suggesting combined deficiencies of steroid 21-hydroxylase and 17α-hydroxylase/17,20-lyase activities. These and other enzymes require electron donation from P450 oxidoreductase. The clinical spectrum of P450 oxidoreductase deficiency ranges from severely affected children with ambiguous genitalia, adrenal insufficiency and the Antley–Bixler skeletal malformation syndrome to mildly affected individuals with polycystic ovary syndrome. We review current knowledge of P450 oxidoreductase deficiency and its broader implications.

Recent findings

Since the first report in 2004, at least 21 P450 oxidoreductase mutations have been reported in over 40 patients. The often subtle manifestations of P450 oxidoreductase deficiency suggest it may be relatively common. P450 oxidoreductase deficiency, with or without Antley–Bixler syndrome, is autosomal recessive, whereas Antley–Bixler syndrome without disordered steroidogenesis is caused by autosomal dominant fibroblast growth factor receptor 2 mutations. In-vitro assays of P450 oxidoreductase missense mutations based on P450 oxidoreductase-supported P450c17 activities provide excellent genotype/phenotype correlations. The causal connection between P450 oxidoreductase deficiency and disordered bone formation remains unclear.


P450 oxidoreductase mutations cause combined partial deficiency of 17α-hydroxylase and 21-hydroxylase. Individuals with an Antley–Bixler syndrome-like phenotype presenting with sexual ambiguity or other abnormalities in steroidogenesis should be analyzed for P450 oxidoreductase deficiency.

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