title: Prevalence of nonclassical congenital adrenal hyperplasia among women self-referred for electrolytic treatment of hirsutism.
abstract: Nonclassical congenital adrenal hyperplasia (NCCAH) is well recognized among women who seek medical attention for hirsutism. However, the prevalence of this disorder among women self-referred for electrolytic treatment of hirsutism is unknown. We hypothesized that the prevalence of NCCAH among women attending an electrolysis clinic might be high. By measuring the morning salivary 17-hydroxyprogesterone (17-OHP) as a screening test for NCCAH in 46 women in the follicular phase of their menstrual cycle, we identified 12 subjects with a high basal salivary 17-OHP. Eleven agreed to have a 60-minute Cosyntropin-stimulation test, as did an additional 6 of 9 women with normal basal salivary 17-OHP, but with a particularly high hirsutism score. One of the women with high basal salivary 17-OHP had a 60-minute Cosyntropin response, which was diagnostic of NCCAH. She was of the Ashkenazi Jewish decent, a group previously reported to have a high prevalence of NCCAH. A second woman with high salivary 17-OPH had a Cosyntropin-stimulation response consistent with heterozygosity for 21-hydroxylase deficiency. None of the Cosyntropin-stimulation responses in those chosen for a high hirsutism score were diagnostic. Thus, 1 of 46 (2.2%) of the women who entered our study had unrecognized NCCAH, a prevalence only about 2-fold greater than that reported in the general population. Therefore, we recommend that electrolysis clinics advise clients from ethnic groups known to have a high frequency of NCCAH of the advisability of having a formal medical evaluation for NCCAH.
authors.affiliation: Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis 55455.
authors.forename: A A
authors.initials: AA
authors.lastname: Killeen
authors.forename: N Q
authors.initials: NQ
authors.lastname: Hanson
authors.forename: R
authors.initials: R
authors.lastname: Eklund
authors.forename: C J
authors.initials: CJ
authors.lastname: Cairl
authors.forename: J H
authors.initials: JH
authors.lastname: Eckfeldt
mesh_terms: D019326:17-alpha-Hydroxyprogesterone; D000312:Adrenal Hyperplasia, Congenital / Q000150:complications / Q000175:diagnosis / Q000453:epidemiology*; D000328:Adult; D003366:Cosyntropin; D004572:Electrolysis / Q000706:statistics & numerical data; D005260:Female; D006628:Hirsutism / Q000150:complications* / Q000453:epidemiology; D006801:Humans; D006908:Hydroxyprogesterones / Q000378:metabolism; D008875:Middle Aged; D015995:Prevalence; D012463:Saliva / Q000201:enzymology
chemical_list: D006908:Hydroxyprogesterones; D003366:Cosyntropin; D019326:17-alpha-Hydroxyprogesterone