21-hydroxylase deficiency screening: Difference between revisions
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According to the the Endocrine Society’s CGS and Clinical Affairs Core Committee, screening for [[congenital adrenal hyperplasia]] due to 21-hydroxylase deficiency by determining the serum level of [[17-hydroxyprogesterone|17OHP]], androstenedione, and [[cortisol]] is recommended in [[newborns]].<ref name="Wikipeadia">https://en.wikipedia.org/wiki/Congenital_adrenal_hyperplasia_due_to_21-hydroxylase_deficiency#Newborn_screening</ref><ref name="pmid19390483">{{cite journal| author=Schwarz E, Liu A, Randall H, Haslip C, Keune F, Murray M et al.| title=Use of steroid profiling by UPLC-MS/MS as a second tier test in newborn screening for congenital adrenal hyperplasia: the Utah experience. | journal=Pediatr Res | year= 2009 | volume= 66 | issue= 2 | pages= 230-5 | pmid=19390483 | doi=10.1203/PDR.0b013e3181aa3777 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19390483 }}</ref> | According to the the Endocrine Society’s CGS and Clinical Affairs Core Committee, screening for [[congenital adrenal hyperplasia]] due to 21-hydroxylase deficiency by determining the serum level of [[17-hydroxyprogesterone|17OHP]], androstenedione, and [[cortisol]] is recommended in [[newborns]].<ref name="Wikipeadia">https://en.wikipedia.org/wiki/Congenital_adrenal_hyperplasia_due_to_21-hydroxylase_deficiency#Newborn_screening</ref><ref name="pmid19390483">{{cite journal| author=Schwarz E, Liu A, Randall H, Haslip C, Keune F, Murray M et al.| title=Use of steroid profiling by UPLC-MS/MS as a second tier test in newborn screening for congenital adrenal hyperplasia: the Utah experience. | journal=Pediatr Res | year= 2009 | volume= 66 | issue= 2 | pages= 230-5 | pmid=19390483 | doi=10.1203/PDR.0b013e3181aa3777 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19390483 }}</ref> | ||
===Newborn screening=== | ===Newborn screening=== | ||
*In the last decade more states and countries are adopting newborn screening for salt-wasting [[congenital adrenal hyperplasia]] due to 21-hydroxylase deficiency, which leads to death in the first month of life | *In the last decade more states and countries are adopting newborn screening for salt-wasting [[congenital adrenal hyperplasia]] due to 21-hydroxylase deficiency, which leads to death in the first month of life if not recognized. | ||
*The [[17-hydroxyprogesterone|17OHP]] level is easy to measure and sensitive (rarely missing real cases), but has a poor specificity. | *The [[17-hydroxyprogesterone|17OHP]] level is easy to measure and sensitive (rarely missing real cases), but has a poor specificity. | ||
Revision as of 18:42, 15 October 2015
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Congenital adrenal hyperplasia due to 21-hydroxylase deficiency Microchapters |
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Differentiating Congenital adrenal hyperplasia due to 21-hydroxylase deficiency from other Diseases |
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Diagnosis |
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Treatment |
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Case Studies |
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21-hydroxylase deficiency screening On the Web |
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American Roentgen Ray Society Images of 21-hydroxylase deficiency screening |
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Directions to Hospitals Treating Congenital adrenal hyperplasia due to 21-hydroxylase deficiency |
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Risk calculators and risk factors for 21-hydroxylase deficiency screening |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Ahmad Al Maradni, M.D. [2]
Overview
According to the the Endocrine Society’s CGS and Clinical Affairs Core Committee, screening for congenital adrenal hyperplasia due to 21-hydroxylase deficiency by determining the serum level of 17OHP, androstenedione, and cortisol is recommended in newborns.[1][2]
Screening
According to the the Endocrine Society’s CGS and Clinical Affairs Core Committee, screening for congenital adrenal hyperplasia due to 21-hydroxylase deficiency by determining the serum level of 17OHP, androstenedione, and cortisol is recommended in newborns.[1][2]
Newborn screening
- In the last decade more states and countries are adopting newborn screening for salt-wasting congenital adrenal hyperplasia due to 21-hydroxylase deficiency, which leads to death in the first month of life if not recognized.
- The 17OHP level is easy to measure and sensitive (rarely missing real cases), but has a poor specificity.
- Screening programs in the United States have reported that 99% of positive screens turn out to be false positives upon investigation of the infant. This is the highest rate of false positives cases among the screening tests for many other congenital metabolic diseases.
- When a positive result is detected, the infant's family and doctor must be notified, and the infant must be referred to a pediatric endocrinologist to confirm or disprove the diagnosis.
- Since most infants with salt-wasting congenital adrenal hyperplasia become critically ill by 2 weeks of age, the evaluation must be done rapidly despite and the screening for elevated 17OHP should be done even if there is a high false positive rate.[1][2]
Genetic counseling
- If a family history of congenital adrenal hyperplasia due to 21-hydroxylase deficiency is present, genetic counseling is recommended for individuals who are planning to conceive.
References
- ↑ 1.0 1.1 1.2 https://en.wikipedia.org/wiki/Congenital_adrenal_hyperplasia_due_to_21-hydroxylase_deficiency#Newborn_screening
- ↑ 2.0 2.1 2.2 Schwarz E, Liu A, Randall H, Haslip C, Keune F, Murray M; et al. (2009). "Use of steroid profiling by UPLC-MS/MS as a second tier test in newborn screening for congenital adrenal hyperplasia: the Utah experience". Pediatr Res. 66 (2): 230–5. doi:10.1203/PDR.0b013e3181aa3777. PMID 19390483.