Journal of South Asian Federation of Obstetrics and Gynaecology

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VOLUME 9 , ISSUE 3 ( July-September, 2017 ) > List of Articles

CASE REPORT

Late-onset Congenital Adrenal Hyperplasia or Early-onset Polycystic Ovarian Syndrome: A Clinical Dilemma

Anuja V Bhalerao, Preksha Jain, Sakshi Aggarwal

Citation Information : Bhalerao AV, Jain P, Aggarwal S. Late-onset Congenital Adrenal Hyperplasia or Early-onset Polycystic Ovarian Syndrome: A Clinical Dilemma. J South Asian Feder Obs Gynae 2017; 9 (3):280-282.

DOI: 10.5005/jp-journals-10006-1513

License: CC BY 3.0

Published Online: 01-09-2017

Copyright Statement:  Copyright © 2017; The Author(s).


Abstract

Aim

To differentiate nonclassical congenital adrenal hyperplasia (NCAH) from polycystic ovarian syndrome (PCOS) in a 13-year-old girl.

Background

Hirsutism and virilization are effects of hyperandrogenism by ovaries and adrenal glands. It has a marked psychological and social impact affecting the quality of life; 75% of premenarchal girl have hyperandrogenism, which is due to PCOS but late-onset congenital adrenal hyperplasia cannot be ruled out, and this leaves the clinician in quandary regarding the diagnosis and management.

Case report

A 13½-year-old girl presented with excessive facial hair, hoarseness of voice, and darkening of elbow pits since past 2 months, which was increasing in severity. The patient had not yet attained menarche but had pubarche 1 year back. Examination revealed presence of acanthosis, underdeveloped breasts, and clitoromegaly >3 cm. Levels of 17-hydroxyprogesterone were normal but higher levels were reported poststimulation. Fasting insulin levels were also high. Appropriate treatment was started, which led to improvement in patient's symptoms.

Conclusion

There is significant overlapping between PCOS and NCAH, which warrants accurate diagnosis based on hormonal analysis to institute early and appropriate therapy.

Significance

Early therapy can prevent infertility and androgenic complications later in life.

How to cite this article

Jain P, Bhalerao AV, Aggarwal S. Late-onset Congenital Adrenal Hyperplasia or Early-onset Polycystic Ovarian Syndrome: A Clinical Dilemma. J South Asian Feder Obst Gynae 2017;9(3):280-282.


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  1. Steroid disorders in children: congenital adrenal hyperplasia and apparent mineralocorticoid excess. Proc Natl Acad Sci U S A 1999 Oct 26;96(22):12790-12797.
  2. Extensive clinical experience: nonclassical 21-hydroxylase deficiency. J Clin Endocrinol Metab 2006 Nov;91(11):4205-4214.
  3. Nonclassical congenital adrenal hyperplasia and the polycystic ovarian syndrome. Ann N Y Acad Sci 1993 May 28;687:193-205.
  4. Congenital adrenal hyperplasia due to steroid 21-hydroxylase deficiency: an endocrine society clinical practice guideline. J Clin Endocrinol Metab 2010 Sep;95(9):4133-4160.
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