21-hydroxylase deficiency differential diagnosis: Difference between revisions

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==Differentiating congenital adrenal hyperplasia due to 21-hydroxylase deficiency from other diseases==
==Differentiating congenital adrenal hyperplasia due to 21-hydroxylase deficiency from other diseases==
[[Congenital adrenal hyperplasia]] due to 21-hydroxylase deficiency must be differentiated from diseases that cause [[ambiguous genitalia]] or virilization:
[[Congenital adrenal hyperplasia]] due to 21-hydroxylase deficiency classic type must be differentiated from diseases that cause [[ambiguous genitalia]]:
{| class="wikitable"
{| class="wikitable"
!Disease name
!Disease name
!
!Elevated
!
Steroids
!
!Decreased steroids
!Androgen status
!Important distinguishing findings
|-
|-
|[[Androgen insensitivity syndrome]]
|Classic type of 21-hydroxylase deficiency
|17-OHP
Progesterone
Androstenedione
DHEA
|Aldosterone
Corticosterone (salt-wasting)
Cortisol (simple virilizing)
|
|-
|[[Congenital adrenal hyperplasia due to 11β-hydroxylase deficiency|11-β hydroxylase deficiency]]
|DOC
11-Deoxy-
cortisol
|Cortisol
Corticosterone
Aldosterone
|
|-
|[[Congenital adrenal hyperplasia due to 17 alpha-hydroxylase deficiency|17-α hydroxylase deficiency]]
|DOC
Corticosterone
Progesterone
|Cortisol
Aldosterone
|
|-
|3β-Hydroxysteroid Dehydrogenase
|DHEA
17-OH pregneno-lone
Pregnenolone
|Cortisol
Aldosterone
|
|-
|Gestational hyperandrogenism
|
|
|
|
|
|-
|
|}
[[Congenital adrenal hyperplasia]] due to 21-hydroxylase deficiency Non-classic type must be differentiated from diseases that cause virilization and hirsutism in female:
{| class="wikitable"
!Disease name
!Elevated
Steroids
!Decreased steroids
!Androgen status
!Important distinguishing findings
|-
|Non-classic type of 21-hydroxylase deficiency
|17-OHP
Exaggerated androstene-dione, DHEA, and 17-OHP
response
to ACTH
|None
|
|
|-
|-
|[[Congenital adrenal hyperplasia due to 11β-hydroxylase deficiency|11-β hydroxylase deficiency]]
|[[Congenital adrenal hyperplasia due to 11β-hydroxylase deficiency|11-β hydroxylase deficiency]]
|DOC
11-Deoxy-
cortisol
|Cortisol
Corticosterone
Aldosterone
|
|-
|[[Congenital adrenal hyperplasia due to 17 alpha-hydroxylase deficiency|17-α hydroxylase deficiency]]
|DOC
Corticosterone
Progesterone
|Cortisol
Aldosterone
|
|-
|3β-Hydroxysteroid Dehydrogenase
|DHEA
17-OH pregneno-lone
Pregnenolone
|Cortisol
Aldosterone
|
|-
|Polycystic ovary syndrome
|
|
|
|
* Polycystic ovaries in sonography
* Obesity
|-
|Adrenal tumors
|
|
|
|-
|Ovarian virilizing tumor
|
|
|
|-
|Cushing's syndrome.
|
|
|
|
|
|
|-
|-
|[[Congenital adrenal hyperplasia due to 17 alpha-hydroxylase deficiency|17-α hydroxylase deficiency]]
|hyperprolactinemia
|
|
|
|
|
|
|-
|-
|[[Polycystic ovarian syndrome]]
|Ovarian hyperthecosis 
|
|
|
|
|
|
|-
|-
|[[Adrenal tumor]]
|Syndromes of severe insulin resistance
|
|
|
|
|
|
|}
|}
The following features may help distinguish nonclassic congenital adrenal hyperplasia and polycystic ovary syndrome [33,34]:
●Nonclassic congenital adrenal hyperplasia is uncommon in African-American and Hispanic-Puerto Rican women [35,36].
●Insulin resistance may be more severe, but probably not more common in polycystic ovarian syndrome [33,34].
●Polycystic ovaries on ultrasound are less common in nonclassic congenital adrenal hyperplasia (40 versus 70 percent) [33,34].
●Obesity is more common in women with polycystic ovary disease [18].


== References ==
== References ==

Revision as of 19:13, 14 July 2017

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Ahmad Al Maradni, M.D. [2]

Overview

Congenital adrenal hyperplasia due to 21-hydroxylase deficiency must be differentiated from 11-β hydroxylase deficiency, 17-α hydroxylase deficiency, androgen insensitivity syndrome, polycystic ovarian syndrome, and adrenal tumor.

Differentiating congenital adrenal hyperplasia due to 21-hydroxylase deficiency from other diseases

Congenital adrenal hyperplasia due to 21-hydroxylase deficiency classic type must be differentiated from diseases that cause ambiguous genitalia:

Disease name Elevated

Steroids

Decreased steroids Androgen status Important distinguishing findings
Classic type of 21-hydroxylase deficiency 17-OHP

Progesterone Androstenedione DHEA

Aldosterone

Corticosterone (salt-wasting) Cortisol (simple virilizing)

11-β hydroxylase deficiency DOC

11-Deoxy- cortisol

Cortisol

Corticosterone Aldosterone

17-α hydroxylase deficiency DOC

Corticosterone Progesterone

Cortisol

Aldosterone

3β-Hydroxysteroid Dehydrogenase DHEA

17-OH pregneno-lone Pregnenolone

Cortisol

Aldosterone

Gestational hyperandrogenism

Congenital adrenal hyperplasia due to 21-hydroxylase deficiency Non-classic type must be differentiated from diseases that cause virilization and hirsutism in female:

Disease name Elevated

Steroids

Decreased steroids Androgen status Important distinguishing findings
Non-classic type of 21-hydroxylase deficiency 17-OHP

Exaggerated androstene-dione, DHEA, and 17-OHP response to ACTH

None
11-β hydroxylase deficiency DOC

11-Deoxy- cortisol

Cortisol

Corticosterone Aldosterone

17-α hydroxylase deficiency DOC

Corticosterone Progesterone

Cortisol

Aldosterone

3β-Hydroxysteroid Dehydrogenase DHEA

17-OH pregneno-lone Pregnenolone

Cortisol

Aldosterone

Polycystic ovary syndrome
  • Polycystic ovaries in sonography
  • Obesity
Adrenal tumors
Ovarian virilizing tumor
Cushing's syndrome.
hyperprolactinemia
Ovarian hyperthecosis 
Syndromes of severe insulin resistance

References

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