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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