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.