Single-Center Experience in Five Patients Diagnosed with Lipoid Congenital Adrenal Hyperplasia Due to Steroidogenic Acute Regulatory Protein (STAR) Gene Variants: A Rare Cause of Adrenal Insufficiency

Lipoid congenital adrenal hyperplasia (LCAH) is the rarest and most severe form of congenital adrenal hyperplasia (CAH), characterized by impaired adrenal and gonadal steroidogenesis. This case series aims to present our clinical experience with five pediatric patients diagnosed with LCAH due to mutations in the Steroidogenic Acute Regulatory (STAR) gene. Clinical and laboratory data from five patients diagnosed with LCAH and followed at the Pediatric Endocrinology Clinic of Akdeniz University Faculty of Medicine Hospital between January 2020 and May 2025 were retrospectively reviewed. The patients, aged 7 days to 6 months, all exhibited a female phenotype and presented with vomiting and feeding difficulties. Three showed hyperpigmentation. Severe hyponatremia, hyperkalemia, elevated ACTH and renin activity, and low cortisol were observed. Aldosterone and 17-OHP were normal; testosterone and precursors were low. Imaging showed bilateral adrenal lipoid infiltration and hyperplasia. Karyotypes included 46,XX (n=3) and 46,XY (n=2). STAR gene mutations identified were c.505G>A, c.33del, and c.288G>T. All received hydrocortisone and fludrocortisone. All survived without morbidity. LCAH is a rare genetic disorder that can present with life-threatening adrenal insufficiency. However, as demonstrated in our cases, early diagnosis and appropriate treatment can lead to excellent outcomes.