21-hydroxylase deficiency laboratory findings
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Congenital adrenal hyperplasia due to 21-hydroxylase deficiency Microchapters |
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor-In-Chief: Mehrian Jafarizade, M.D [2]
Overview
Laboratory findings consistent with the diagnosis of congenital adrenal hyperplasia due to 21-hydroxylase deficiency include hyponatremia, hyperkalemia, and low [[cortisol
Laboratory Findings
Laboratory findings consistent with the diagnosis of congenital adrenal hyperplasia due to 21-hydroxylase deficiency include:
| 21-hydroxylase deficiency type | 17-hydroxyprogesterone | 17-hydroxyprogesterone | ACTH stimulation testing greater than 200 ng/dL |
|---|---|---|---|
| classic salt wasting | |||
| classic non-salt wasting | |||
| Non-classic type |
Salt-wasting crises in infancy
- Basic chemistries will reveal hyponatremia, with a serum Na+ typically between 105 and 125 mEq/L. Hyperkalemia in these infants can be extreme—levels of K+ above 10 mEq/L are not unusual—as can the degree of metabolic acidosis. Hypoglycemia may be present. This is termed a salt-wasting crisis and rapidly causes death if not treated.[1]
Childhood onset (simple virilizing) congenital adrenal hyperplasia
- Diagnosis of simple virilizing congenital adrenal hyperplasia type is usually confirmed by discovering extreme elevations of 17-hydroxyprogesterone along with moderately high testosterone levels. Cosyntropin stimulation test may be needed in mild cases, but usually the random levels of 17OHP are high enough to confirm the diagnosis.[1]
Late onset (nonclassical) congenital adrenal hyperplasia
- Diagnosis of late-onset congenital adrenal hyperplasia may be suspected from a high 17-hydroxyprogesterone level, but some cases are so mild that the elevation is only demonstrable after cosyntropin stimulation.[1]