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Review Question - QID 106795

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QID 106795 (Type "106795" in App Search)
A 17-year-old girl is brought to the pediatrician by her father for evaluation. He is concerned that she has not undergone puberty yet, while all of her classmates at school have. The patient herself feels well overall, with no specific complaints. Examination shows vital signs of T 98.9, HR 71, and BP 145/92. The physician notes undeveloped breasts and normal external and internal female genitalia in Tanner I stage of development. Her body mass index is within normal limits, she is in the 40th percentile for height, and she is agreeable and pleasant during the interview. Which of the following additional findings is likely present in this patient?

Aromatase enzyme deficiency

35%

52/150

Hypokalemia

35%

53/150

Increased levels of sex hormones

8%

12/150

XY karyotype

9%

14/150

Hypercortisolism

7%

10/150

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This patient has clinical features consistent with 17-alpha hydroxylase deficiency, a form of congenital adrenal hyperplasia (CAH). 17-alpha hydroxylase deficiency leads to increased aldosterone, causing hypokalemia.

CAH is classified based on the enzymatic defect present, most commonly 21-hydroxylase deficiency followed by 11-beta-hydroxylase deficiency, and then 17-alpha-hydroxylase deficiency. These different defects create different phenotypes in male and female patients with CAH and can be distinguished both clinically and by laboratory studies. 17-alpha hydroxylase deficiency leads to decreased production of cortisol and sex hormones, routing production instead towards mineralocorticoids. This leads to hypertension and hypokalemia. In females, it causes absence of secondary sex characteristics with normal internal sex organs.

Incorrect Answers:
Answer 1: Aromatase deficiency is not associated with 17-alpha-hydroxylase deficiency.
Answer 3: Decreased levels of sex hormones are seen in 17-alpha-hydroxylase deficiency.
Answer 4: This patient is expected to have a normal female XX karyotype.
Answer 5: This patient would be expected to have low cortisol activity due to the enzyme deficiency.

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