Thursday, 23 May 2019

Stop before you label as ordinary PCO with slight male pattern hair growth and acne. This may be a case of late onset CAH.

How to exclude minor adrenal disorders in young adults who reports with slight male pattern hair growth and acne. This is not to be confuse with Androgen Excess Disorders which was earlier termed as PCO


 Tips to diagnose late onset Adrenal hyperplasia?
Congenital adrenal hyperplasia is an inherited autosomal recessive enzyme defect that results in metabolic disorders and masculinization of newborn females. It is fortunately rare. A milder form, with onset at or following menarche, is variously labeled late-onset, adult-onset, acquired, partial, attenuated and non-classical adrenal hyperplasia. The most common form is due to 21-hydroxylase deficiency; other forms are due to 11β-hydroxylase deficiency and 3β-hydroxysteroid dehydrogenase deficiency. Clinical signs include mild hirsutism, increased skin sebum   causing mild acne, increased scalp sebum making daily hair washing necessary and mild hypertension. The diagnosis is confirmed by 17-hydroxyprogesterone (17OHP) levels ≥ 200 ng/dL or dehydroepiandrosterone sulfate (DHEAS) levels ≥ 180 μg/dL, which may also originate in the ovary. Elevated DHEAS is more common in mild cases and can be measured first. 17OHP should be measured first if there is virilization (hirsutism, male-pattern baldness or clitoral enlargement). Treatment for either defect is low-dose corticosteroid (0.5 mg dexamethasone or 5 mg prednisone) daily at bedtime. The addition of CC is often necessary or ovulation. Corticosteroids should be discontinued after ovulation, because of the risk of birth defects. Amenorrhea and excess androgen may be due to Cushing’s syndrome or acromegaly. Rapid development of virilization may be due to an androgen-producing

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