{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,9]],"date-time":"2026-05-09T09:32:30Z","timestamp":1778319150974,"version":"3.51.4"},"reference-count":39,"publisher":"Public Library of Science (PLoS)","issue":"12","license":[{"start":{"date-parts":[[2022,12,20]],"date-time":"2022-12-20T00:00:00Z","timestamp":1671494400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:p>Glucocorticoids (GC) replacement are the mainstay treatment for 21-hydroxylase deficiency (21-OHD), the most common cause of congenital adrenal hyperplasia (CAH), in its classical form. There are novel insights into the genetic basis of the GC action diversity that point to an important role for GC receptor (GR) gene polymorphisms, suggesting a possible modulation in occurrence of metabolic disorders, what may be relevant to clinical management of 21-OHD. The aim of this study was to investigate whether the five GR gene polymorphisms <jats:italic>Tth111<\/jats:italic>I, <jats:italic>ER22<\/jats:italic>, <jats:italic>23EK<\/jats:italic>, <jats:italic>Bcl<\/jats:italic>I, <jats:italic>9\u03b2<\/jats:italic> (rs10052957, rs6189, rs6190, rs41423247, rs6198) and their combination into haplotypes are associated to different GC response in a cohort of classic 21-OHD subjects. GR genotype-phenotype associations were explored after a dexamethasone suppression test using very low-doses (VLD-DST), 20 and 40 \u03bcg\/m\u00b2. The final sample (n = 28) was selected based on the 102 individuals\u2019 previous genotypes classification, according to literature data of GC sensitivity or resistance. Thus, only patients with GC increased resistance (n = 18) or increased sensitivity (n = 10) profiles were selected. Out of 28 subjects aged 12 (2\u201334) years enrolled in this study, 75% were females, 75% presented the salt-wasting form (SW) and 25% the simple virilizing form (SV). Subjects who carried <jats:italic>Tth111<\/jats:italic>I and <jats:italic>9\u03b2<\/jats:italic>, associated or not to the <jats:italic>ER22\/23EK<\/jats:italic> variants, showed an impaired DST response. Results did not differ significantly according to gender or body mass index. SV subjects with GC hypersensitivity-genotypes showed decreased average cortisol levels compared to those with GC resistance-genotypes (p = 0.0023). The <jats:italic>Tth111<\/jats:italic>I <jats:italic>+ 9\u03b2\/ Wild<\/jats:italic> or <jats:italic>Tth111<\/jats:italic>I <jats:italic>+ ER22\/23EK + 9\u03b2\/ Wild<\/jats:italic> genotypes were associated to GC resistance in this population. This finding may be relevant given the challenges posed by therapeutic management with GC in CAH.<\/jats:p>","DOI":"10.1371\/journal.pone.0279298","type":"journal-article","created":{"date-parts":[[2022,12,20]],"date-time":"2022-12-20T18:37:01Z","timestamp":1671561421000},"page":"e0279298","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":5,"title":["Pharmacogenomic markers of glucocorticoid response in congenital adrenal hyperplasia"],"prefix":"10.1371","volume":"17","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4356-9806","authenticated-orcid":true,"given":"Cristina","family":"Botelho Barra","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7133-863X","authenticated-orcid":true,"given":"Thais Ramos","family":"Villela","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nedst\u00e2ni de Freitas","family":"Soares","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Enrico Ant\u00f4nio","family":"Colosimo","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Andr\u00e9 Rolim","family":"Belis\u00e1rio","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9222-3882","authenticated-orcid":true,"given":"Ana Cristina Sim\u00f5es","family":"e Silva","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3585-4917","authenticated-orcid":true,"given":"Ivani 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