[…] during late childhood, adolescence or adulthood) Clinical manifestations Two clinical subtypes exist: Salt-wasting type 67% of all classic forms Males present 7–14 days after birth with failure to thrive, dehydration, vomiting, and shock Females present [amboss.com]

May present in adolescence /early adulthood (nonclassic adrenal hyperplasia). May be severe and present in infancy (classic adrenal hyperplasia). 21-hydroxylase deficiency is the most common form ( 90%). [pedemmorsels.com]

No difference in age of presentation was noted between males and females ( p 0.541). The clinical presentation was significantly different between the CSW and SV groups, and between males and females in the CSW group ( p Conclusion. [samj.org.za]

It presents at puberty because of reduced adrenal androgen production ( hypogonadism ). Females with 17-hydroxylase deficiency present with delayed puberty : they do not menstruate, and breasts and pubic hair fail to develop. [dermnetnz.org]

Presentation can vary from mild (failure to thrive) to catastrophic (sudden infant death). [bettersafercare.vic.gov.au]

• Sepsis

  sepsis )! References: [4] [7] [9] [12] [amboss.com]

  Frequently, presenting males are assumed to have sepsis or pyloric stenosis. The major clinical indication of CAH is the presence of pigmented genitalia and nature of the electrolyte disturbance. [bettersafercare.vic.gov.au]

• Salt Craving

  Clinical features of 21-hydroxylase deficiency Acute adrenal insufficiency Due to lack of cortisol and aldosterone High blood pressure Salt-craving Dehydration Vomiting Genital ambiguity Due to excess androgens Affects females only Known as ‘female pseudohermaphroditism [dermnetnz.org]

  Patients may complain of salt craving and lightheadedness due to dehydration. Excessive fludrocortisone treatment can lead to hypertension that is often asymptomatic in the pediatric population. [clinchem.aaccjnls.org]

• Fracture

  Body composition, bone density and fractures Glucocorticoids increase the fat mass and reduce muscle mass and bone density, while androgens have the opposite effect. [tidsskriftet.no]

  Use of oral corticosteroids and risk of fractures. J Bone Miner Res. (2000) 15:993–1000. doi: 10.1359/jbmr.2000.15.6.993 PubMed Abstract CrossRef Full Text Google Scholar 46. Nebesio TD, Renbarger JL, Nabhan ZM, Ross SE, Slaven JE, Li L, et al. [frontiersin.org]

• Hirsutism

  Manifestations seen in females are hirsutism, acne, anovulation and menstrual irregularities. Males (and some females) are asymptomatic. Hirsutism continues in adulthood and women can suffer from chronic anovulation and fertility problems. [orpha.net]

  Tabs Content Clinical Overview Diagnosis Indications for Testing Ambiguous genitalia or unexplainable electrolyte results in infancy Premature sexual development in older children Hirsutism and irregular menses in adult females Laboratory Testing Initial [arupconsult.com]

  Also useful as part of a battery of tests to evaluate females with hirsutism or infertility, which can result from adult-onset CAH. [mayocliniclabs.com]

  Symptoms include hirsutism, acne, androgenic alopecia, anovulation, menstrual dysfunction, and infertility. In a multicenter study, the most common symptoms among adolescent and adult women were hirsutism (59%), oligomenorrhea (54%), and acne (33%). [frontiersin.org]

  In addition to the growth of male body hair (hirsutism), a change in voice can also occur. Patients do not reach female puberty and therefore suffer from amenorrhea and infertility. [lecturio.com]

• Thin Skin

  Too much steroid hormone results in suppression of growth in children, weight gain, abdominal obesity, hypertension, thin skin, and later in life the risk of cardiovascular disease and osteoporosis. [diurnal.co.uk]

• Increased Libido

  libido Accelerated bone age Absent or irregular menstrual periods Male pattern of hair growth ( hirsutism ) Oily skin ( seborrhoea ) Acne Androgenetic alopecia Late-onset in males Premature puberty Accelerated bone age Enlargement of testes, due to adrenal [dermnetnz.org]

• Testicular Mass

  […] some suggest limb width greater than 4 mm and length greater than 20 mm) wrinkled surface of adrenals cerebriform pattern of the adrenal glands : characteristic sign normal ultrasound appearances may also be seen testicular masses may be identified representing [radiopaedia.org]

  In adolescent boys, poor CAH control can cause growth of testicular masses that resemble adrenal tissue, called testicular adrenal rests (TART). [chop.edu]

  Adult gonadal function depends on adequate adherence to treatment; ovarian dysfunction in women and testicular masses in men worsen when adherence is poor. [analesdepediatria.org]

[…] genetic counseling and prenatal diagnosis of adrenal hyperplasia Newborn screening programs for 21-hydroxylase deficiency may be lifesaving in an affected male infant who would otherwise be undetected until presentation with a salt-wasting crisis [5] See Workup [emedicine.medscape.com]

• Hyponatremia

  Aldosterone deficiency can lead to salt wasting, hyponatremia, and hyperkalemia. [msdmanuals.com]

  […] classic CAH If nonclassic form is suspected in adult female, obtain 17-OHP at 0800 hours and during follicular phase of menstrual cycle Further evaluation should include assessment of salt wasting Serum sodium, potassium, and renin activity – expect hyponatremia [arupconsult.com]

  Management is as follows: Patients with dehydration, hyponatremia, or hyperkalemia and a possible salt-wasting form of CAH should receive an IV bolus of isotonic sodium chloride solution (20 mL/kg or 450 mL/m 2 ) over the first hour, as needed, to restore [emedicine.medscape.com]

  Aldosterone deficiency leads to Hyponatremia and Hyperkalemia. Cortisol deficiency leads to poor cardiac function, general insensitivity to catecholamines, and increased secretion of antidiuretic hormone. [pedemmorsels.com]

  You should check a basic metabolic panel to assess for hyponatremia, hyperkalemia, acidosis, and hypoglycemia, which can be associated with adrenal insufficiency and salt wasting. [childrenscolorado.org]

[…] that one third of the mothers who received dexamethasone treatment during pregnancy would not elect treatment in a future pregnancy. 51 Current Recommendations for Prenatal Diagnosis and Treatment Prenatal diagnosis and treatment is performed most commonly [pediatrics.aappublications.org]

Moreover, the risk for poor treatment compliance, in case of multiple daily doses treatment regimens, should not be excluded. [clinicaltrials.gov]

Ongoing monitoring Treatment of CAH can be challenging. Excessive treatment with glucocorticoids can lead to stunted growth, excessive weight gain and other long-term problems such as osteoporosis. [chop.edu]

They may need treatment through a drip to replace fluid, salt and glucose. They will need long-term glucocorticoid treatment. What surgical treatment is available? Surgery is sometimes offered when a baby girl has unusual genitalia. [patient.info]

Treatment General treatment and follow-up Follow-up of the patients is focused on hormonal as well as psychological factors at all life stages. In newborns, key issues relate to diagnostics, sex determination and avoiding adrenal crises. [tidsskriftet.no]

The long-term prognosis for individuals with CAH is usually favorable, and with lifelong treatment, affected individuals typically have good health and normal lifespans. [sema4.com]

Prognosis With proper treatment patients may have a normal life expectancy. The documents contained in this web site are presented for information purposes only. [orpha.net]

Prognosis With adequate medical and surgical therapy, the prognosis is good. However, problems with psychological adjustment are common and usually stem from the genital abnormality that accompanies some forms of congenital adrenal hyperplasia. [emedicine.medscape.com]

Last updated: 12/27/2014 The long-term outlook ( prognosis ) for people with congenital adrenal hyperplasia (CAH) is usually good. [rarediseases.info.nih.gov]

Etiology In 90-95% of cases, CAH is caused by a mutation in the CYP21A2 gene located on chromosome 6p21.3 which encodes for an enzyme that controls cortisol and aldosterone production. [orpha.net]

Surg Pathol 2001;25:1443 ) Congenital lipoid adrenal hyperplasia: very rare, low cortisol and aldosterone secretion, high levels of ACTH, FSH, LH and plasma rennin; present with severe adrenal insufficiency in neonatal period; usually die in infancy Etiology [pathologyoutlines.com]

Phenotype strongly correlates with genotype and reflects residual activity if there is a milder mutation. “21-OH Deficiency” Image created by Lecturio Etiology of Congenital Adrenal Hyperplasia The disease results from genetic mutations and two copies [lecturio.com]

[…] deficiency generally have ambiguous genitalia or female genitalia; they may be raised as girls and seek medical attention later in life because of hypertension or a lack of breast development Other findings Patients with aldosterone deficiency of any etiology [emedicine.medscape.com]

Summary Epidemiology The estimated prevalence is 1/10,000 and annual incidence ranges from 1/5,000 to 1/15,000. [orpha.net]

Epidemiology Race Congenital adrenal hyperplasia occurs among people of all races. Congenital adrenal hyperplasia secondary to CYP21A1 mutations and deletions is particularly common among the Yupik Eskimos. [emedicine.medscape.com]

[…] androstenedione, and testosterone Every 3 months during infancy and every 3-6 months thereafter For assessment of mineralocorticoid replacement Blood pressure measurement Plasma renin/renin activity Aldosterone and potassium levels may also be helpful Background Epidemiology [arupconsult.com]

License: CC BY 2.0 Epidemiology of Congenital Adrenal Hyperplasia Congenital adrenal hyperplasia, or CAH, is the most frequent cause of Pseudohermaphroditism femininus (chromosomal and gonadal female, habitus male). [lecturio.com]

Epidemiology and genetics Based on neonatal screening, the global prevalence of classical congenital adrenal hyperplasia is approximately 1/15 000, but there is wide variation between population groups ( 1 ). [tidsskriftet.no]

Pathophysiology CAH is a result of autosomal recessive defects in enzymes that are responsible for the production of cortisol. [amboss.com]

Cytochrome P450 oxidoreductase deficiency Hexose-6-phosphate dehydrogenase deficiency ( H6PD variant) PAPSS2 deficiency ( PAPSS2 variant) Congenital lipoid adrenal hyperplasia ( StAR variants) P450scc side chain cleavage enzyme deficiency ( CYP11A1 variant) Pathophysiology [arupconsult.com]

Pathophysiology of Congenital Adrenal Hyperplasia Due to the defect in 21-hydroxylase, cortisol is not produced or is only produced to some extent. Thus, the disease may vary in phenotypic presentation depending on the amount of secreted hormone. [lecturio.com]

VIVO Pathophysiology Congenital adrenal hyperplasias (CAH) are a group of heritable disorders associated with an inability or deficiency in the ability to produce cortisol. [vivo.colostate.edu]

Clinical Information Discusses physiology, pathophysiology, and general clinical aspects, as they relate to a laboratory test The cause of congenital adrenal hyperplasia (CAH) is an inherited genetic defect that results in decreased formation of 1 of [mayocliniclabs.com]

Consequently, the clinical consequences of CAHs arise from an insufficiency of certain corticosteroids and excesses of others. 21-hydroxylase Deficiency Biochemistry Defects of 21-hydroxylase prevent synthesis of aldosterone and cortisol. [pathwaymedicine.org]

[…] female fetus with classic CAH, whereas therapy after that time would prevent progression of virilization. [pediatrics.aappublications.org]

It cannot identify pregnancies that require treatment so it cannot prevent treatment in female foetuses that are unaffected or carriers. [analesdepediatria.org]

Genetic Disorders and the Fetus: Diagnosis, Prevention and Treatment. John Wiley and Sons. pp. 600–. ISBN 978-1-4051-9087-9. Retrieved 14 June 2010. Richard D. McAnulty, M. [en.wikipedia.org]

It must be taken daily throughout life to prevent effects of CAH. [newbornscreening.info]