GlandACTHAldosteroneMedullaAndrogensDeficiencyHormonesAdrenocorticotropicLayer of the adrenalGlucocorticoidTumors of the adrenalAndrogenAddison'sDysfunctionGroup of autosomal recessive disordersCentral adrenal insufficiencySynthesisProduced in the adrenal glandsDisordersSymptomsNeoplasmsDestruction of the adrenalHemorrhageEndocrine glandsHormoneSurrounding the adrenal glandsOvaryDisorderTestosteroneGlucocorticoidsSecondaryDiagnosisOuterThyroidInfectionsZona fasciculataAdenomasCarcinomaChronic2022
Gland41
- Congenital adrenal hyperplasia - Inherited disorder of gland (adrenal). (wikipedia.org)
- Measurements of DHEAS provides information about the adrenal gland function and can help with the diagnosis of congenital adrenal hyperplasia and polycystic ovary syndrome. (cdc.gov)
- Adrenal insufficiency (Addison disease) can be classified as primary, which occurs when the adrenal gland itself is dysfunctional, or secondary, also called central adrenal insufficiency, which occurs when a lack of secretion of corticotropin-releasing hormone (CRH) from the hypothalamus or of adrenocorticotropic hormone (ACTH) from the pituitary leads to hypofunction of the adrenal cortex. (medscape.com)
- aldosterone secreting adenoma in one adrenal gland. (docsbay.net)
- The pituitary gland produces adrenocorticotropic hormone (ACTH), which stimulates the adrenal glands to produce other hormones. (medicalnewstoday.com)
- Secondary adrenal deficiency can also develop when a person uses steroid drugs that affect the hypothalamus and the pituitary gland and prevent the body from producing ACTH. (medicalnewstoday.com)
- 1970. Normal and pathologic anatomy of the adrenal gland of the mouse, including neoplasms. (nih.gov)
- ACTH) is a 39 amino acid peptide hormone produced by cells of the anterior pituitary gland and carried by the peripheral circulation to its effector organ, the adrenal cortex, where it stimulates the synthesis and secretion of glucocorticoids and, to a more modest extent. (kembrel.com)
- As shown in the diagram, each gland consists of an encapsulated cortex and an inner medulla. (aacc.org)
- Dehydroepiandrosterone sulfate (DHEAS): Because testosterone can originate in either the adrenal cortex or the ovary, an elevated testosterone level does not indicate the gland of origin. (medscape.com)
- Your adrenal glands are controlled in part by your hypothalamus and pituitary gland. (clevelandclinic.org)
- Each adrenal gland have two main parts - adrenal cortex and medulla, each producing different hormones. (anatomy.app)
- The right one is pyramid-shaped, while the left adrenal gland is semilunar-shaped and a bit larger. (anatomy.app)
- To the anterior side of the right adrenal gland are the inferior vena cava and right lobe of the liver , while posteriorly lies the right crus of the diaphragm. (anatomy.app)
- The stomach , pancreas , and spleen are located in front of the left adrenal gland, while the left crus of the diaphragm is behind the left gland. (anatomy.app)
- Each adrenal gland consists of two parts: outer part known as the adrenal cortex , and inner part - adrenal medulla . (anatomy.app)
- The adrenal cortex is the outer part of the adrenal gland, and it is also the largest part. (anatomy.app)
- We also discuss the causes, diagnoses, and treatment options related to adrenal gland disorders. (medicalnewstoday.com)
- The cortex is the outer part of the gland. (medicalnewstoday.com)
- When this happens, it is known as an adrenal gland disorder. (medicalnewstoday.com)
- The following sections discuss the most common adrenal gland disorders. (medicalnewstoday.com)
- This condition develops when the adrenal gland itself does not function well and cannot make enough cortisol. (medicalnewstoday.com)
- However, a doctor may need to remove them if they interfere with adrenal gland function or reach a certain size. (medicalnewstoday.com)
- Although rare, this cancer can affect the cortex, which is the outer part of the adrenal gland. (medicalnewstoday.com)
- This cancer occurs in childhood and may begin in the medulla, which is the inner part of the adrenal gland. (medicalnewstoday.com)
- When sustained, ACTH elevation promotes adrenal gland enlargement. (frontiersin.org)
- The adrenal gland is located on the superior portion of the kidney. (targetwoman.com)
- Many metabolic pathways depend upon the adrenal gland functionality through its hormone production. (targetwoman.com)
- Some of the significant hormones produced by the adrenal gland include aldosterone, cortisol, sex hormones and adrenaline. (targetwoman.com)
- The adrenal gland comprises two distinctive regions cortex and medulla respectively. (targetwoman.com)
- Each region of the adrenal gland produces different kinds of hormones. (targetwoman.com)
- Adrenal Pheochromocytoma is a condition in which tumors are formed on the adrenal gland. (targetwoman.com)
- These tumors occur predominantly on one adrenal gland as an unilateral condition. (targetwoman.com)
- Tumors associated with the adrenal cortex fall into the functional category whereas the remaining part of the adrenal gland secreting mixed hormones such as sex hormones and aldosterone fall under the nonfunctional category. (targetwoman.com)
- Metastases associated with adrenal gland are more prominent in the determination of preexisting neoplasms and underlying adrenal insufficiency. (targetwoman.com)
- They removed the tumor which was on my right adrenal gland they removed my right adrenal gland, my right kidney, part of my liver and some of my lymph nodes. (globalgenes.org)
- These involve the cerebral cortex, the pituitary gland, the ovaries and the uterus. (gynaeonline.com)
- Adrenal Gland Disorders are disorders of your adrenal glands when they make too much or too little hormone. (endocrineassociatesdallas.com)
- Adrenal gland disorders are problems that arise in one or both adrenal glands. (endocrineassociatesdallas.com)
- Addison's disease is a rare disorder characterized by chronic and insufficient functioning of the outer layer of the adrenal gland (adrenal cortex). (rarediseases.org)
- Patients with Addison's disease have a deficiency in the production of glucocorticoid hormones which are manufactured by the adrenal gland. (rarediseases.org)
ACTH19
- Cushing's disease - Physiopathology of hyperplasia of adrenal cortex due to increased circulating level of ACTH (adrenocorticotropic hormone). (wikipedia.org)
- A diagnosis of adrenal insufficiency is confirmed if the serum cortisol level is less than 18 mcg/dL in the presence of a markedly elevated serum ACTH concentration and plasma renin activity. (medscape.com)
- Based on normative data of children of various ages, adrenal insufficiency is likely if the serum cortisol concentration is less than 18 mcg/dL 30-60 minutes after administration of 250 mcg of cosyntropin (synthetic ACTH 1-24). (medscape.com)
- When a patient's serum cortisol response to cosyntropin is subnormal but his or her serum ACTH level is not elevated, the possibility of central adrenal insufficiency should be considered. (medscape.com)
- ACTH stimulates the production of cortisol and androgens in the adrenal cortex. (endotext.org)
- Adrenocortical adenoma encapsulated, expansile, yellow tumors, lipid-rich cells, adjacent adrenal cortex and contralateral adrenal glands are atrophic b/c of suppression of endogenous ACTH by high cortisol levels. (docsbay.net)
- Signs & Symptoms ACTH deficiency can either be congenital or acquired, and its manifestations are clinically indistinguishable from those of glucocorticoid deficiency. (kembrel.com)
- Too much ACTH in the body causes the adrenal glands to produce cortisol in high levels. (kembrel.com)
- A decline in the concentration of ACTH in the blood leads to a reduction in the secretion of adrenal hormones, resulting in adrenal insufficiency (hypoadrenalism). (kembrel.com)
- Serum cortisol inhibits the secretion of both CRH and ACTH to prevent excessive secretion of cortisol from the adrenal glands. (medscape.com)
- ACTH not only stimulates cortisol secretion but also promotes growth of the adrenal cortex in conjunction with growth factors such as insulinlike growth factor (IGF)-1 and IGF-2. (medscape.com)
- A mere 2 weeks' exposure to pharmacologic doses of glucocorticoids can suppress the corticotropin-releasing hormone (CRH)-adrenocorticotropic hormone (ACTH)-adrenal axis. (medscape.com)
- Other causes of central adrenal insufficiency include congenital or acquired hypopituitarism and ACTH unresponsiveness. (medscape.com)
- Unlike most adrenal hormones regulated heavily through the hypothalamic-pituitary-adrenal axis, secretion of aldosterone depends minimally on the action of corticotropin-releasing hormone (CRH) and adrenocorticotropin hormone (ACTH). (aacc.org)
- Because cortisol synthesis is decreased, adrenocorticotropic hormone (ACTH) levels increase, which stimulates the adrenal cortex, causing accumulation of cortisol precursors (eg, 17- hydroxyprogesterone ) and excessive production of the adrenal androgens dehydroepiandrosterone (DHEA) and androstenedione. (merckmanuals.com)
- Without ACTH, the adrenals do not receive a signal to make cortisol. (medicalnewstoday.com)
- Deficient adrenal production of glucocorticoids or mineralocorticoids results in adrenocortical insufficiency, which is either the consequence of destruction or dysfunction of the cortex (primary adrenocortical insufficiency (PAI), or Addison disease and congenital adrenal hyperplasia (CAH)) or secondary to deficient pituitary ACTH secretion (secondary adrenocortical insufficiency, discussed elsewhere, see section hypopituitarism). (oncohemakey.com)
- The increased ACTH concentrations lead to chronic stimulation of the adrenal cortex and overstimulate adrenal steroidogenesis, resulting in an accumulation of steroids above the enzymatic blockage. (frontiersin.org)
- Secondary adrenal insufficiency is caused by deficient secretion of ACTH. (difusireview.com)
Aldosterone9
- Mineralocorticoid replacement is required only in primary adrenal insufficiency, because aldosterone secretion is reduced in primary adrenal insufficiency but not in central adrenal insufficiency. (medscape.com)
- The zona glomerulosa produces aldosterone, and the zonae fasciculata and reticularis together produce cortisol and adrenal androgens. (medscape.com)
- Damage to the cortex can disrupt the production of hormones such as cortisol, aldosterone, and androgens. (medicalnewstoday.com)
- More specifically, it stimulates secretion of glucocorticoids such as cortisol, and has little control over secretion of aldosterone, the other major steroid hormone from the adrenal cortex. (kembrel.com)
- The main causes of PA are bilateral adrenal hyperplasia and aldosterone producing adenomas, accounting for 65-70% and 30-35% of all PA cases, respectively. (aacc.org)
- A mutation or deletion of any of the genes that code for enzymes involved in cortisol or aldosterone synthesis results in congenital adrenal hyperplasia. (medscape.com)
- Overview of Congenital Adrenal Hyperplasia Congenital adrenal hyperplasia is a group of genetic disorders, each characterized by inadequate synthesis of cortisol, aldosterone, or both. (merckmanuals.com)
- These include Addison's disease, Cushing's syndrome, and adrenal cancer, as well as high blood pressure due to the overproduction of aldosterone. (medicalnewstoday.com)
- Thus, the zona glomerulosa , which produces aldosterone, lacks 17α-hydroxylase activity and cannot synthesize 17α-hydroxypregnenolone and 17α-hydroxyprogesterone, which are the precursors of cortisol and the adrenal androgens. (oncohemakey.com)
Medulla11
- The adrenal glands consist of two layers: the medulla, which is the interior layer, and the cortex, the outer layer. (medicalnewstoday.com)
- The medulla produces epinephrine-like hormones, while the cortex secretes corticosteroids . (medicalnewstoday.com)
- As listed in the table, the adrenal cortex synthesizes steroid hormones, whereas the medulla produces catecholamines. (aacc.org)
- Adrenal glands have two main parts: Adrenal medulla (inside) and adrenal cortex (outside). (clevelandclinic.org)
- Your adrenal glands are composed of two parts: the cortex (outer region) and the medulla (inner part). (clevelandclinic.org)
- The adrenal medulla, the inner part of your adrenal glands, produces and releases the catecholamines adrenaline and noradrenaline. (clevelandclinic.org)
- They also differ in their embryonic development, so the adrenal cortex and medulla can actually be considered as two separate endocrine glands. (anatomy.app)
- The cortex totally encloses the adrenal medulla. (anatomy.app)
- The cells of the zona fasciculata are arranged in parallel radial cords that resemble long strings or bundles of sticks (fasciculi), stretching from the zona glomerulosa down in the direction of the adrenal medulla. (anatomy.app)
- Each adrenal is composed of two parts: the inner portion, called the adrenal medulla, and the outer portion called the adrenal cortex. (endocrineassociatesdallas.com)
- Each layer of the adrenal cortex and the adrenal medulla produce a different hormone. (endocrineassociatesdallas.com)
Androgens7
- Laboratory studies in hirsutism serve both to confirm the clinical impression of hyperandrogenism and to identify the source of excess androgens, either adrenal or ovarian. (medscape.com)
- Dexamethasone-mediated suppression of androgens is observed in healthy women who do not have hirsutism and in those with congenital adrenal hyperplasia (CAH) and idiopathic hirsutism. (medscape.com)
- Diagnosis is by measurement of cortisol, its precursors, and adrenal androgens, sometimes after adrenocorticotropic hormone administration. (merckmanuals.com)
- Background: Children with congenital adrenal hyperplasia (CAH) need chronic glucocorticoid therapy, both to replace congenital deficit in cortisol synthesis and to suppress the overproduction of androgens by the adrenal cortex. (eurospe.org)
- The adrenal cortex, the outer region of your adrenal glands, produce and release glucocorticoids, mineralocorticoids and adrenal androgens, which are all types of steroid hormones. (clevelandclinic.org)
- The direct biologic activity of the adrenal androgens (androstenedione, DHEA, and DHEA sulfate) is minimal, and they function primarily as precursors for peripheral conversion to the active androgenic hormones, testosterone, and dihydrotestosterone. (oncohemakey.com)
- this peripherally converted DHEA and that secreted by the adrenal cortex can be further converted in peripheral tissues to androstenedione, the immediate precursor of the active androgens. (oncohemakey.com)
Deficiency9
- On the other hand, congenital adrenal hyperplasia and Addison diasease result in deficiency of adrenal hormones. (aacc.org)
- Congenital Adrenal Hyperplasia is a group of autosomal recessive disorders resulting from deficiency of enzymes essential for the synthesis of cortisol. (bilpubgroup.com)
- Deficiency in 21-hydroxylase causes more than 90% of cases of congenital adrenal hyperplasia (CAH). (ralfmed.com)
- Testosterone, Total, Serum - Testosterone testing is used in the evaluation of androgen excess or deficiency related to gonadal function, adrenal function, or tumor activity. (walkinlab.com)
- In the very rare case of congenital adrenal hyperplasia due to 17α-hydroxylase deficiency cortisol production is blocked. (wikipedia.org)
- Pathogenetic component of these signs is congenital disorder of steroidogenesis caused by 11β-hydroxylase deficiency and symptoms of androgen excess. (iitta.gov.ua)
- The adrenal insufficiencies associated with mineralocorticoids are caused because of underlying conditions such as corticosterone methyl oxidase deficiency, impairments in the Zona glomerulosa and treatments such as heparin therapy. (targetwoman.com)
- Patients with destruction of the adrenal cortices or with classic 21-hydroxylase deficiency also have mineralocorticoid deficiency, typically with hyponatremia, volume depletion, and hyperkalemia. (difusireview.com)
- In contrast, mineralocorticoid deficiency is not present in patients with familial corticosteroid deficiency, Allgrove syndrome, or secondary adrenal insufficiency. (difusireview.com)
Hormones7
- Consequently, the adrenal glands will also produce lower levels of hormones. (medicalnewstoday.com)
- The adrenal hormones help regulate several bodily functions including metabolism, blood pressure and your body's response to stress. (clevelandclinic.org)
- Your adrenal glands often release these hormones, like other adrenal hormones, when you're in physically and emotionally stressful situations. (clevelandclinic.org)
- The adrenal glands regulate metabolism, immune system, blood pressure, and even response to stress by synthesizing and secreting steroid hormones in the bloodstream. (anatomy.app)
- Cells of the adrenal cortex are classified into three types that produce specific hormones, and they are arranged in three layers or zones . (anatomy.app)
- Sometimes, the adrenal glands produce too much or not enough of their hormones. (medicalnewstoday.com)
- The adrenal glands are responsible for making several hormones and catecholamines (i.e., adrenaline). (endocrineassociatesdallas.com)
Adrenocorticotropic1
- Adrenocorticotropic hormone, as its name implies, stimulates the adrenal cortex. (kembrel.com)
Layer of the adrenal1
- This is the outer layer of the adrenal glands. (medicalnewstoday.com)
Glucocorticoid3
- Glucocorticoid replacement is required in all forms of adrenal insufficiency. (medscape.com)
- During biosynthesis of the glucocorticoid cortisol the enzyme 21-hydroxylase converts 17-OH progesterone to 11-desoxycortisol in the adrenal cortex. (ralfmed.com)
- However, in humans , cortisol is the primary glucocorticoid that is produced primarily in the zona fasciculata of the adrenal cortex . (wikipedia.org)
Tumors of the adrenal3
- Testosterone levels may be requested in women to investigate the cause of anovulation, amenorrhea, hirsutism, virilization, masculinizing tumors of ovary, tumors of the adrenal cortices, and congenital adrenal hyperplasia (high values). (walkinlab.com)
- These are benign tumors of the adrenal cortex. (medicalnewstoday.com)
- Examples of these abnormalities are interstitial cell tumors of the testicle, hyperplasia, or tumors of the adrenal cortex. (mhmedical.com)
Androgen3
- Accordingly, measurement of elevated plasma levels of DHEAS, an androgen synthesized almost exclusively by the adrenal cortex, can indicate excess adrenal function. (medscape.com)
- In both forms, adrenal androgen levels are elevated, causing virilization. (merckmanuals.com)
- His PhD entitled 'Molecular Regulation of Adrenal Androgen Biosynthesis' was awarded in 2015. (birmingham.ac.uk)
Addison's6
- Addison's disease, or adrenal insufficiency, is usually an autoimmune disease, resulting from a faulty immune response. (medicalnewstoday.com)
- Addison's disease occurs when damage to the adrenal cortex disrupts hormone production in the adrenal glands. (medicalnewstoday.com)
- In Addison's disease, the immune system attacks cells of the adrenal glands, and they gradually stop working. (medicalnewstoday.com)
- Studies imply that autoimmune diseases such as Addison's disease are the predominant cause for the adrenal sufficiency. (targetwoman.com)
- This abnormal production results in Congenital Adrenal Hyperplasia, Addison's disease or other types of adrenal dysfunction. (endocrineassociatesdallas.com)
- When first described, this disorder was thought to involve only adrenal insufficiency (Addison's disease) and thyroid insufficiency (Hashimoto's thyroiditis). (rarediseases.org)
Dysfunction2
- Adrenal insufficiency is a disorder predominantly associated with the dysfunction of the adrenal cortex region. (targetwoman.com)
- Primary adrenal insufficiency (Addison disease) is caused by dysfunction or absence of the adrenal cortices. (difusireview.com)
Group of autosomal recessive disorders1
- Congenital adrenal hyperplasia (CAH) is a group of autosomal recessive disorders that disrupt adrenal steroidogenesis. (frontiersin.org)
Central adrenal insufficiency2
- 10 d) central adrenal insufficiency (eg, a patient who recently underwent surgery of the hypothalamus or pituitary regions). (medscape.com)
- Iatrogenic central adrenal insufficiency as well as acquired and congenital primary adrenal insufficiency (Addison disease) are briefly discussed in this section. (medscape.com)
Synthesis1
- With congenital adrenal syndrome, a group of metabolic disorders, the hormone synthesis in the adrenal cortex is disturbed. (ralfmed.com)
Produced in the adrenal glands2
- 17α-hydroxyprogesterone (17-OHP) is a steroid hormone that is primarily produced in the adrenal glands, as well as in ovaries, testes, and placenta. (cdc.gov)
- Androstenedione is a steroid hormone that is produced in the adrenal glands and the gonads. (cdc.gov)
Disorders1
- Although autoimmune disorders play a major role in the adrenal insufficiencies, other causes such as infectious diseases, vascular impairments, congenital disorders and also iatrogenic causes lead to adrenal insufficiencies. (targetwoman.com)
Symptoms2
- The symptoms of adrenal insufficiency can be difficult to spot. (medicalnewstoday.com)
- The symptoms of adrenal Pheochromocytoma include headaches, palpitation, profuse sweating, glucose intolerance , heat sensitivity and decreased blood pressure. (targetwoman.com)
Neoplasms1
- Finally, we discuss the possible future role of these white matter maps in the assessment of white matter diseases, congenital brain malformations, central nervous system neoplasms (presurgical evaluation), and brain function. (ajronline.org)
Destruction of the adrenal1
- In developed countries, the most common cause of adrenal insufficiency (Addison disease) is autoimmune destruction of the adrenal cortex. (medscape.com)
Hemorrhage1
- Computed tomography (CT) scanning is the imaging study of choice in the evaluation of adrenal insufficiency and helps to identify adrenal hemorrhage, calcifications, and infiltrative disease. (medscape.com)
Endocrine glands2
- Your adrenal glands are endocrine glands located on top of your kidneys. (clevelandclinic.org)
- Other endocrine glands like the thyroid, the pancreas and the adrenal cortex also have a role to play in causing amenorrhoea. (gynaeonline.com)
Hormone1
- Corticosterone , also known as 17-deoxycortisol and 11β,21-dihydroxyprogesterone , [1] is a 21-carbon steroid hormone of the corticosteroid type produced in the cortex of the adrenal glands . (wikipedia.org)
Surrounding the adrenal glands1
- This layer lies immediately below the fatty capsule surrounding the adrenal glands. (anatomy.app)
Ovary2
- Estradiol is produced primarily in the ovary (follicle, corpus luteum), but small quantities are also formed in the testes and in the adrenal cortex, as well as in fat cells. (cdc.gov)
- Endogenous testosterone is synthesized by cells in the testis, ovary, and adrenal cortex. (beligasdirect.com)
Disorder1
- The intensity of this disorder can be represented as primary or secondary depending upon the impaired adrenal cortex and its functionality. (targetwoman.com)
Testosterone4
- Therapeutically, testosterone is used in the management of hypogonadism, either congenital or acquired. (beligasdirect.com)
- Extremely high testosterone levels are likely to be associated with adrenal or ovarian tumors, whereas idiopathic and benign etiologies result in very mild elevations. (medscape.com)
- Elevations in both testosterone and DHEAS suggest an adrenal origin, whereas an isolated testosterone elevation indicates an ovarian source. (medscape.com)
- The adrenal glands are also an important source of sex steroids, such as estrogen and testosterone. (lupus.org)
Glucocorticoids1
- Most cases of adrenal insufficiency (Addison disease) are iatrogenic, caused by long-term administration of glucocorticoids. (medscape.com)
Secondary3
- A person may have primary or secondary adrenal insufficiency. (medicalnewstoday.com)
- The term primary indicates the hypersecretory defect is at the adrenal glands, as opposed to secondary in which the hyperaldosteronism is of extra-adrenal origin. (aacc.org)
- Acute adrenal crisis is more commonly seen in primary adrenal insufficiency than in secondary adrenal insufficiency. (difusireview.com)
Diagnosis4
- Measurement of 17-OHP is useful in the diagnosis of congenital adrenal hyperplasia (CAH). (cdc.gov)
- Measurement of androstenedione is useful in the diagnosis of congenital adrenal hyperplasia, in conjunction with other androgenic precursors, such as 17α-hydroxyprogesterone. (cdc.gov)
- [ 4 ] Therefore, the diagnosis of adrenal insufficiency in premature infants remains problematic. (medscape.com)
- The diagnosis of adrenal insufficiency in HIV patients is often problematic. (difusireview.com)
Outer1
- The zona glomerulosa is the outer part of the adrenal cortex. (anatomy.app)
Thyroid1
- OMIM 269200) consists of type 1 diabetes mellitus, autoimmune thyroid disease, and adrenal failure. (medscape.com)
Infections1
- Infections of the adrenal glands , particularly with cytomegalovirus, are found in nearly half of patients with untreated HIV at autopsy. (difusireview.com)
Zona fasciculata1
- The middle zone of the adrenal cortex is called zona fasciculata. (anatomy.app)
Adenomas1
- Most tumors that affect the adrenal cortex are adenomas. (medicalnewstoday.com)
Carcinoma2
- Lisa with Adrenal Cortex Carcinoma, 'I Had to Fight for My Treatment Plan. (globalgenes.org)
- I was 35 years old when I was diagnosed with Adrenal Cortex Carcinoma-stage IV, metastasized to the lungs. (globalgenes.org)
Chronic2
- Increased skin pigmentation and salt craving are common among individuals with chronic primary adrenal insufficiency. (medscape.com)
- Crisis may occur in the course of treatment of chronic adrenal insufficiency, or it may be the presenting manifestation of adrenal insufficiency. (difusireview.com)
20221
- Published November 3, 2022 at 628 × 354 in Congenital Adrenal Hyperplasia . (endotext.org)