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| ==Complications== | | ==Complications== |
| *==Screening==
| | ==Screening== |
| ==Diagnosis== | | ==Diagnosis== |
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| {| align="center" style="border: 0px; font-size: 90%; margin: 3px;"
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| ! align="center" style="background:#DCDCDC;" |'''Criteria for the diagnosis of diabetes'''
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| | align="left" style="background:#F5F5F5;" |[[Fasting plasma glucose|FPG]] ≥126 mg/dL (7.0 mmol/L). Fasting is defined as no caloric intake for at least 8 h.
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| | align="center" style="background:#F5F5F5;" |'''OR'''
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| | align="left" style="background:#F5F5F5;" |2-h [[Blood glucose|Plasma Glucose]] (PG) ≥200 mg/dL (11.1 mmol/L) during an [[Glucose tolerance test|OGTT]]. The test should be performed as described
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| by the [[WHO]], using a glucose load containing the equivalent of 75 g anhydrous glucose dissolved in water.
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| | align="center" style="background:#F5F5F5;" |'''OR'''
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| | align="left" style="background:#F5F5F5;" |[[A1C]] ≥6.5% (48 mmol/mol).
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| | align="center" style="background:#F5F5F5;" |'''OR'''
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| | align="left" style="background:#F5F5F5;" |In a patient with classic symptoms of [[hyperglycemia]] or [[hyperglycemic]] crisis, a random [[plasma glucose]] ≥200 mg/dL (11.1 mmol/L).
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| |}
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| ===Gestational diabetes===
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| There are 2 strategies to confirm the GDM diagnosis.
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| *'''One-step''' 75-g Oral glucose tolerance test (OGTT)
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| ::::::'''OR'''
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| *'''Two-step''' approach with a 50-g (nonfasting) ''screen'' followed by a 100-g OGTT for those who screen positive.<ref name="pmid26807004">{{cite journal |vauthors= |title=Standards of Medical Care in Diabetes-2016 Abridged for Primary Care Providers |journal=Clin Diabetes |volume=34 |issue=1 |pages=3–21 |year=2016 |pmid=26807004 |doi=10.2337/diaclin.34.1.3 |url=}}</ref>
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| ===One Step Strategy====
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| Perform a 75 g glucose tolerance test in 24-28 weeks of pregnancy and read the measures 1 h and 2 h after glucose ingestion as well as fasting glucose.<ref name="pmid26807004">{{cite journal |vauthors= |title=Standards of Medical Care in Diabetes-2016 Abridged for Primary Care Providers |journal=Clin Diabetes |volume=34 |issue=1 |pages=3–21 |year=2016 |pmid=26807004 |doi=10.2337/diaclin.34.1.3 |url=}}</ref>
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| The OGTT should be performed in the morning after an overnight fast of at least 8 h.
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| The diagnosis of GDM is made when any of the following plasma glucose values are met or exceeded:
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| * Fasting: 92 mg/dL (5.1 mmol/L)
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| * 1 h: 180 mg/dL (10.0 mmol/L)
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| * 2 h: 153 mg/dL (8.5 mmol/L)
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| ====Two Step Strategy====
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| In this approach, screening with a 1 h 50-g glucose load test (GLT) followed by a 3 h 100-g OGTT for those who screen positive.<ref name="pmid26696673">{{cite journal |vauthors= |title=Professional Practice Committee for the Standards of Medical Care in Diabetes-2016 |journal=Diabetes Care |volume=39 Suppl 1 |issue= |pages=S107–8 |year=2016 |pmid=26696673 |doi=10.2337/dc16-S018 |url=}}</ref>
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| The diagnosis of GDM is made when at least 2 out of 4 measures of 3 h 100-g OGTT became abnormal.
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| *The following table summarizes the diagnostic approach for gestational diabetes.
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| {| class="wikitable"
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| ! rowspan="2" |
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| ! colspan="4" |Cut off (mg/dl)
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| !Fasting
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| !1 Hour
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| !2 Hour
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| !3 Hour
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| :One step test
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| :::2 hour 75 g glucose tolerance test
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| |92
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| |180
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| |153
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| | ----
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| |-
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| :Two step test
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| :::1 hour 50 g screening test
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| | ----
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| |140
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| | ----
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| | ----
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| |-
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| :::3 hour 100 g test if screening test became positive
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| :::::Carpenter/Coustan approach<ref name="pmid7148898">{{cite journal |vauthors=Carpenter MW, Coustan DR |title=Criteria for screening tests for gestational diabetes |journal=Am. J. Obstet. Gynecol. |volume=144 |issue=7 |pages=768–73 |year=1982 |pmid=7148898 |doi= |url=}}</ref>
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| |95
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| |180
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| |155
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| |140
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| |-
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| :::::National Diabetes Data Group (NDDG) approach<ref name="pmid510803">{{cite journal |vauthors= |title=Classification and diagnosis of diabetes mellitus and other categories of glucose intolerance. National Diabetes Data Group |journal=Diabetes |volume=28 |issue=12 |pages=1039–57 |year=1979 |pmid=510803 |doi= |url=}}</ref>
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| |105
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| |190
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| |165
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| |145
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| |}
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| ==Prevention== | | ==Prevention== |
| Life style modification is the mainstay of prevention of diabetes mellitus. It includes, changes in diet, weight reduction and exercise. The strongest evidence for diabetes prevention comes from the Diabetes Prevention Program (DPP). The DPP demonstrated that an intensive lifestyle intervention could reduce the incidence of type 2 diabetes by 58% over 3 years.<ref name="pmid17098085">{{cite journal |vauthors=Lindström J, Ilanne-Parikka P, Peltonen M, Aunola S, Eriksson JG, Hemiö K, Hämäläinen H, Härkönen P, Keinänen-Kiukaanniemi S, Laakso M, Louheranta A, Mannelin M, Paturi M, Sundvall J, Valle TT, Uusitupa M, Tuomilehto J |title=Sustained reduction in the incidence of type 2 diabetes by lifestyle intervention: follow-up of the Finnish Diabetes Prevention Study |journal=Lancet |volume=368 |issue=9548 |pages=1673–9 |year=2006 |pmid=17098085 |doi=10.1016/S0140-6736(06)69701-8 |url=}}</ref>
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| ==References== | | ==References== |
| {{reflist|2}} | | {{reflist|2}} |
This page contains general information about Congenital adrenal hyperplasia. For more information on specific types, please visit the pages on 21-hydroxylase deficiency, 17a-Hydroxylase deficiency, 11β-hydroxylase deficiency, 3-beta-hydroxysteroid dehydrogenase, Cytochrome P450-oxidoreductase (POR) deficiency (ORD), congenital lipoid adrenal hyperplasia, cholesterol side-chain cleavage enzyme deficiency
.
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Mehrian Jafarizade, M.D [2]
Synonyms and keywords: Congenital adrenal hyperplasia, CAH, Adrenal hyperplasia
Overview
Classification
Congenital adrenal hyperplasia is classified into seven types based on the genetic causes that lead to hyperplasia and hormonal imbalance.
| Disease
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History and symptoms
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Laboratory findings
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Additional findings
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| Blood pressure
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Genitalia
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| 21-hydroxylase deficiency
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Classic type
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- Normal in non-salt-wasting
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- Male: normal or scrotal pigmentation and large phallus
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| Non-classic type
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- Female: virilization after puberty
- Male: normal appearance
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| 17a-Hydroxylase deficiency
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| 11β-hydroxylase deficiency
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| 3-beta-hydroxysteroid dehydrogenase
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| Cytochrome P450-oxidoreductase (POR) deficiency (ORD)
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| Congenital lipoid adrenal hyperplasia
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| Cholesterol side-chain cleavage enzyme deficiency
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Complications
Screening
Diagnosis
Prevention
References