21-hydroxylase deficiency history and symptoms: Difference between revisions

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!Male
!Male
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|Classical salt wasting
|Classical type
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* Ambiguous genitalia
* Ambiguous genitalia
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* Clitoral enlargement
* Clitoral enlargement
* Labial fusion
* Labial fusion
* Vomiting, weight loss and dehydration in a baby’s first few weeks of life.
* Vomiting, weight loss and dehydration in a baby’s first few weeks of life in salt wasting type
* Early puberty
* Early puberty
* Adult short stature  
* Adult short stature  
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* Male-typical cognitive pattern (better performance on spatial tasks, worse performance on verbal tasks)
* Male-typical cognitive pattern (better performance on spatial tasks, worse performance on verbal tasks)
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* Adrenal rest tumors due to sustained elevations in ACTH
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* Testicular adrenal rest tumors
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|Classical non-salt wasting
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* Decreased fertility due to hyperandrogenemia and anovulatory cycles(fertility rate depends the enzyme amount).
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* Adrenal rest tumors due to sustained elevations in ACTH
* Adrenal rest tumors due to sustained elevations in ACTH

Revision as of 19:30, 13 July 2017

Congenital adrenal hyperplasia due to 21-hydroxylase deficiency Microchapters

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor-In-Chief: Mehrian Jafarizade, M.D [2]

Overview

Classic CAH salt-wasting CAH Baby girls with ambiguous genitalia with life-threatening cases of vomiting, weight loss and dehydration in a baby’s first few weeks of life or simple virilizing CAH but girls will have ambiguous genitalia. baby boys may have enlarged penises. nonclassic or late onset CAH Patients don't show any signs in early life but show  premature pubarche, acne, hirsutism.

History and Symptoms

Symptom of 21-hydroxylase deficiency ranges from severe to mild or asymptomatic forms, depending on the degree of 21-hydroxylase enzyme deficiency. There are three main clinical phenotypes: classic salt-wasting, classic non-salt-wasting (simple virilizing), and non-classic (late-onset):[1][2][3][4][5][6][7][8][9]

21-OH deficiency type Common symptoms Less common symptoms
Child Female Male Child Female Male
Classical type
  • Ambiguous genitalia
  • Clitoral enlargement
  • Labial fusion
  • Vomiting, weight loss and dehydration in a baby’s first few weeks of life in salt wasting type
  • Early puberty
  • Adult short stature
  • Male-typical sexual behavior in girls and cross-gender role behavior
  • Ambiguous genitalia
  • Clitoral enlargement
  • labial fusion
  • Deep voice
  • Greater aggressive tendencies than unaffected healthy women
  • Decreased fertility due to hyperandrogenemia and anovulatory cycles (fertility rate depends the enzyme amount).
  • Normal appearing at birth(mostly)
  • Hyperpigmentation of the scrotum
  • Enlarged phallus
  • Deep voice
  • Muscle growth
  • Early virilization at two to four years of age with (pubic hair, growth spurt, adult body odor).
  • Cognitive function disturbance such as IQ impairment
  • Male-typical cognitive pattern (better performance on spatial tasks, worse performance on verbal tasks)
  • Adrenal rest tumors due to sustained elevations in ACTH
  • Testicular adrenal rest tumors
Late onset disease
  • Hirsutism, acne and menstrual irregularity in young women
  • Early pubarche or sexual precocity in school age children
  • No symptoms
  • Short stature
  • Decreased fertility due to hyperandrogenemia and anovulatory cycles(fertility rate depends the enzyme amount).

 


References

  1. Eugster EA, Dimeglio LA, Wright JC, Freidenberg GR, Seshadri R, Pescovitz OH (2001). "Height outcome in congenital adrenal hyperplasia caused by 21-hydroxylase deficiency: a meta-analysis". J Pediatr. 138 (1): 26–32. doi:10.1067/mpd.2001.110527. PMID 11148508.
  2. Mathews GA, Fane BA, Conway GS, Brook CG, Hines M (2009). "Personality and congenital adrenal hyperplasia: possible effects of prenatal androgen exposure". Horm Behav. 55 (2): 285–91. doi:10.1016/j.yhbeh.2008.11.007. PMC 3296092. PMID 19100266.
  3. Mulaikal RM, Migeon CJ, Rock JA (1987). "Fertility rates in female patients with congenital adrenal hyperplasia due to 21-hydroxylase deficiency". N Engl J Med. 316 (4): 178–82. doi:10.1056/NEJM198701223160402. PMID 3491959.
  4. Stikkelbroeck NM, Hermus AR, Braat DD, Otten BJ (2003). "Fertility in women with congenital adrenal hyperplasia due to 21-hydroxylase deficiency". Obstet Gynecol Surv. 58 (4): 275–84. doi:10.1097/01.OGX.0000062966.93819.5B. PMID 12665708.
  5. Hagenfeldt K, Janson PO, Holmdahl G, Falhammar H, Filipsson H, Frisén L; et al. (2008). "Fertility and pregnancy outcome in women with congenital adrenal hyperplasia due to 21-hydroxylase deficiency". Hum Reprod. 23 (7): 1607–13. doi:10.1093/humrep/den118. PMID 18420648.
  6. Stikkelbroeck NM, Suliman HM, Otten BJ, Hermus AR, Blickman JG, Jager GJ (2003). "Testicular adrenal rest tumours in postpubertal males with congenital adrenal hyperplasia: sonographic and MR features". Eur Radiol. 13 (7): 1597–603. doi:10.1007/s00330-002-1786-3. PMID 12835972.
  7. Stikkelbroeck NM, Hermus AR, Suliman HM, Jager GJ, Otten BJ (2004). "Asymptomatic testicular adrenal rest tumours in adolescent and adult males with congenital adrenal hyperplasia: basal and follow-up investigation after 2.6 years". J Pediatr Endocrinol Metab. 17 (4): 645–53. PMID 15198296.
  8. Stikkelbroeck NM, Suliman HM, Otten BJ, Hermus AR, Blickman JG, Jager GJ (2003). "Testicular adrenal rest tumours in postpubertal males with congenital adrenal hyperplasia: sonographic and MR features". Eur Radiol. 13 (7): 1597–603. doi:10.1007/s00330-002-1786-3. PMID 12835972.
  9. Nordenskjöld A, Holmdahl G, Frisén L, Falhammar H, Filipsson H, Thorén M; et al. (2008). "Type of mutation and surgical procedure affect long-term quality of life for women with congenital adrenal hyperplasia". J Clin Endocrinol Metab. 93 (2): 380–6. doi:10.1210/jc.2007-0556. PMID 18029470.