Reproductive Case: 6-day-old Girl with Vomiting and Poor Feeding

00:01 Let's go on to another case A 6-day old newborn girl is brought to the hospital by a mother because of excessive vomiting and poor feeding.

00:10 The mother did not have any antenatal care.

00:13 Her temperature is 36.8 degrees celsius, her blood pressure is 50/30 mmHg and her pulse rate is 150 beats per minute.

00:23 On examination, the infant is dehydrated and demonstrates signs of shock The genitalia are ambiguous with a fused labia and an enlarged clitoris Lab results show a sodium of 125 mEq/L, a potassium of 6 mEq/L and a serum 17-hydroxyprogesterone level of 100,000 ng/dL What is the most likely cause of this infant's condition? Here we have a newborn who presents with vomiting and poor feeding.

00:58 There was no prenatal care and no evaluation of the mother during pregnancy She has a low blood pressure and evidence of shock.

01:07 The patient is dehydrated, she has abnormal genitalia but she also has hyponatremia.

01:13 A normal sodium level would be around 140 and here hers is 125 Coupled with the hypokalemia and the low blood pressure, we're thinking very strongly about an adrenal problem here causing her presentation.

01:29 Confirming this is the high level of 17-hydroxyprogesterone.

01:35 We perfom a ACTH stimulation test to confirm the diagnosis of congenital adrenal hyperplasia.