Elevated DHEA is associated with deficiency of which enzyme in congenital adrenal hyperplasia?

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Multiple Choice

Elevated DHEA is associated with deficiency of which enzyme in congenital adrenal hyperplasia?

Explanation:
Elevated DHEA points to a block at the step that converts DHEA to the next androgen. That step is mediated by 3β-hydroxysteroid dehydrogenase. When this enzyme is deficient, DHEA cannot be efficiently converted to androstenedione, so DHEA accumulates while downstream androgens drop. Other enzyme defects shift the pathway differently: 21-hydroxylase deficiency mainly causes a buildup of 17-hydroxyprogesterone with increased androgens, not a characteristic rise in DHEA; 11β-hydroxylase deficiency leads to accumulation of 11-deoxycortisol and DOC with hypertension; 17α-hydroxylase deficiency markedly reduces sex steroids including DHEA, so DHEA would not be elevated.

Elevated DHEA points to a block at the step that converts DHEA to the next androgen. That step is mediated by 3β-hydroxysteroid dehydrogenase. When this enzyme is deficient, DHEA cannot be efficiently converted to androstenedione, so DHEA accumulates while downstream androgens drop.

Other enzyme defects shift the pathway differently: 21-hydroxylase deficiency mainly causes a buildup of 17-hydroxyprogesterone with increased androgens, not a characteristic rise in DHEA; 11β-hydroxylase deficiency leads to accumulation of 11-deoxycortisol and DOC with hypertension; 17α-hydroxylase deficiency markedly reduces sex steroids including DHEA, so DHEA would not be elevated.

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