Congenital lipoid adrenal hyperplasia caused by a frame-shift mutation in the steroidogenic acute regulatory protein gene.

We present a female patient who, at the age of 35 days, presented with adrenal insufficiency with salt loss. Clinical and endocrinological investigation (low to normal levels of all adrenal steroids and raised ACTH) and imaging studies suggested congenital lipoid adrenal hyperplasia. The diagnosis was confirmed by molecular analysis that showed a frame-shift mutation 947/InsA/948 in exon 7 of the steroidogenic acute regulatory protein (StAR) gene. The patient is thriving under glucocorticoid and mineralocorticoid replacement therapy. She is now 10.5 years old and has not presented any signs of puberty.