Congenital adrenal hyperplasia Health Article

Definition

Congenital adrenal hyperplasia refers to a group of inherited disorders of the adrenal gland.

Alternative Names

Adrenogenital syndrome; 21-hydroxylase deficiency

Causes, incidence, and risk factors

Congenital adrenal hyperplasia can affect both boys and girls. People with congenital adrenal hyperplasia lack an enzyme needed by the adrenal gland to make the hormones cortisol and aldosterone.

Without these hormones, the body produces more androgen, a type of male sex hormone. This causes male characteristics to appear early (or inappropriately).

About 1 in 10,000 to 18,000 children are born with congenital adrenal hyperplasia.

Symptoms

Girls will usually have normal internal female reproductive organs (ovaries, uterus, and fallopian tubes). They may have the following external changes:

• Abnormal menstrual periods
• Genitals that look both male and female (ambiguous genitalia), often appearing more male than female
• Deep voice
• Early appearance of pubic and armpit hair
• Excessive hair growth and facial hair
• Failure to menstruate

Boys won't have any obvious problems at birth. However, they may appear to enter puberty as early as 2-3 years of age. Changes may include:

• Deep voice
• Early appearance of pubic and armpit hair
• Early development of masculine characteristics
• Enlarged penis
• Small testes
• Well-developed muscles

Both boys and girls will be tall as children but significantly shorter than normal as adults.

Some forms of congenital adrenal hyperplasia are more severe and cause adrenal crisis in the newborn due to loss of salt. In this form of congenital adrenal hyperplasia, newborns develop severe symptoms shortly after birth, including:

• Cardiac arrhythmias
• Dehydration
• Electrolyte changes
• Vomiting

Signs and tests

• Abnormal salt levels in blood (serum electrolytes) and urine
• High levels of 17-OH progesterone
• High levels of serum DHEA sulfate
• High levels of urinary 17-ketosteroids
• Low levels of aldosterone and cortisol
• Normal or low urinary 17-hydroxycorticosteroids
• X-ray for bone age (shows older bones than normal for the person's age)

Genetic tests can help diagnose, confirm, and manage the disease.

This disease may also affect the results of the following tests:

• Estriol - serum
• Estriol - urine
• Pregnanediol