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Condenital Adrenal Hyperplasia

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7 Figure 2. Diagnosis of 21OHD Morning 17OHP (Follicular Phase) <200 ng/dL (<6 nmol/L) 200–1,000 ng/dL (6-30 nmol/L) >1,000 ng/dL (>30 nmol/L) Cosyntropin Stimulation Test <1,000 ng/dL (<30 nmol/L) 21OHD Excluded 21OHD Reference standards for hormonal diagnosis were derived from Armengaud J-B et al. J Clin Endocrinol Metab. 2009;94(8):2835–2840; Bidet Met al. J Clin Endocrinol Metab. 2009;94(5):1570–1578; Torok D et al. Exp Clin Endocrinol Diabetes. 2003;111(1):27–32; Speiser PW et al. Clin Endocrinol (Oxf ). 1998;49(4):411–417; Wedell Aet al. J Clin Endocrinol Metab. 1994;78(5):1145–1152. ese diagnostic thresholds appear similar for LC-MS/MS assays from limited data (Wilson RCet al. J Clin Endocrinol Metab. 1995;80(8):2322–2329). Note that randomly measured 17OHP levels can be normal in NCCAH; hence, 17OHP levels should be screened in the early morning (before 8 AM). For menstruating females, steroid measurements should be obtained in the follicular phase and may differ depending on the assay employed. Individuals with classic CAH, including both salt-wasting and simple virilizing forms of 21OHD, typically have unstimulated 17OHP values of several thousand. Note that it is sometimes difficult to distinguish clinically between non–salt-wasting classic and nonclassic forms of CAH.

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