JCRPE (Sep 2020)

Neonatal Screening for Congenital Adrenal Hyperplasia in Turkey: Outcomes of Extended Pilot Study in 241,083 Infants

  • Tülay Güran,
  • Başak Tezel,
  • Meltem Çakır,
  • Ayşehan Akıncı,
  • Zerrin Orbak,
  • Mehmet Keskin,
  • Beray Selver Eklioğlu,
  • Alev Ozon,
  • Mehmet Nuri Özbek,
  • Gülay Karagüzel,
  • Nihal Hatipoğlu,
  • Fatih Gürbüz,
  • Filiz Mine Çizmecioğlu,
  • Cengiz Kara,
  • Enver Şimşek,
  • Firdevs Baş,
  • Murat Aydın,
  • Feyza Darendeliler

DOI
https://doi.org/10.4274/jcrpe.galenos.2020.2019.0182
Journal volume & issue
Vol. 12, no. 3
pp. 287 – 294

Abstract

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Objective:Turkish Directorate of Public Health introduced the first pilot screening program for congenital adrenal hyperplasia (CAH) in four Turkish cities in 2017, and in 2018 extended the program, with a slight change in screening strategy, to fourteen cities. To evaluate the performance of the extended study and update previously reported outcomes.Methods:Retrospective, descriptive study. Neonates of ≥32 gestational weeks and ≥1500 gr birth weight from fourteen cities, born between May-December 2018, were included. Screening protocol included one sample, two-tier testing as applied in the previous pilot study. In the first step, 17α-hydroxyprogesterone (17-OHP) was measured by fluoroimmunoassay in dried blood spots (DBS) obtained at 3-5 days of life. Cases with positive initial screening underwent second tier testing by steroid profiling in DBS using liquid chromatography-tandem mass spectrometry to measure 17-OHP, 21-deoxycortisol (21-S), cortisol (F), 11-deoxycortisol and androstenedione. The babies with a steroid ratio (21-S+17-OHP)/F of ≥0.7 (increased from ≥0.5 in the earlier pilot study) were referred to pediatric endocrinology clinics for diagnostic assessment.Results:In the evaluated period, 241,083 newborns were screened. 12,321 (5.11%) required second-tier testing and 880 (0.36%) were referred for clinical assessment, twenty of whom were diagnosed with CAH (10 females, 10 males). Sixteen were diagnosed as classical 21-hydroxylase deficiency (21-OHD) CAH (12 with salt-wasting and four with simple virilising CAH), and four cases were identified with 11β-OHD CAH. No case of salt-wasting CAH was missed by neonatal screening (sensitivity was 100%). The incidence of classical 21-OHD and 11β-OHD in the screened population was 1:15,067 and 1:60,270, respectively.Conclusion:Turkish neonatal CAH screening effectively led to earlier diagnosis of 21-OHD and 11β-OHD, using steroid profiling as a second-tier test. This will result in improved care of these patients in the future.

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