CAH Panel (Androstenedione, 17 OH Progesterone, Total Testosterone, Cortisol, Aldosterone)

CAH Panel is a combined hormone assessment that includes androstenedione, 17-hydroxyprogesterone, total testosterone, cortisol, and aldosterone. The panel provides information about steroid-hormone production by the adrenal glands and supports evaluation of congenital adrenal hyperplasia and related endocrine disorders.

Congenital adrenal hyperplasia (CAH) refers to a group of inherited conditions caused by reduced activity of an enzyme required for adrenal steroid production. The most common form is associated with 21-hydroxylase deficiency. Reduced cortisol production can lead to increased ACTH stimulation and excessive production of adrenal androgen hormones.

Benefits of the Test

• Measures multiple adrenal and androgen hormones in one panel.
• Supports evaluation of suspected congenital adrenal hyperplasia.
• Helps assess abnormal adrenal steroid production.
• Measures 17-hydroxyprogesterone, an important CAH screening marker.
• Assesses androstenedione and total testosterone concentrations.
• Provides information about cortisol production.
• Includes aldosterone for mineralocorticoid assessment.
• Supports evaluation of virilisation and androgen excess.
• May assist monitoring of patients receiving CAH treatment.
• Helps guide additional dynamic, genetic, or imaging investigations.

Why Doctors Recommend This Test

Doctors may recommend this panel when a newborn, child, adolescent, or adult has symptoms suggesting CAH or another adrenal steroid-production disorder. These may include ambiguous genital development, early pubic hair, rapid childhood growth, early puberty, severe acne, excessive facial or body hair, irregular menstrual cycles, infertility, or unexplained androgen excess.

It may also be ordered for patients with low cortisol, salt-wasting symptoms, low blood pressure, electrolyte abnormalities, or a known diagnosis of CAH requiring treatment monitoring.

Preparation Before Test

• The sample is generally collected in the early morning because hormone levels vary during the day.
• Fasting may be advised depending on the doctor’s instructions and associated tests.
• Women may be asked to test during the early follicular phase of the menstrual cycle.
• Inform the doctor about pregnancy or hormonal contraception.
• Provide details of steroids, hormone medicines, and all other medications.
• Do not stop glucocorticoids or other prescribed medicines without medical supervision.
• Avoid strenuous exercise and significant stress before collection when possible.
• Inform the doctor about recent illness, surgery, or major sleep-cycle changes.
• Follow the exact timing instructions if the sample is part of an ACTH stimulation test.
• Carry previous hormone, electrolyte, imaging, or genetic reports for comparison.

Normal Reporting Time

The CAH Panel includes several specialised hormone measurements that require individual analysis, validation, and clinical correlation. Results are generally available within a few working days after sample collection and processing. The exact reporting time may vary according to testing schedules, analytical methods, and laboratory workflow.

Who Should Take This Test?

This panel may be recommended for:

• Newborns with suspected congenital adrenal hyperplasia.
• Children with early puberty or rapid growth.
• Patients with ambiguous genital development.
• Girls or women with excessive facial hair or severe acne.
• Women with irregular periods, infertility, or androgen excess.
• Patients with an elevated 17-hydroxyprogesterone result.
• Individuals with suspected adrenal insufficiency or salt-wasting.
• Patients with a family history of congenital adrenal hyperplasia.
• Individuals undergoing treatment monitoring for diagnosed CAH.
• People specifically advised to undergo a CAH hormone panel by an endocrinologist.

Detailed Information

The adrenal glands produce several steroid hormones from cholesterol. These include cortisol, aldosterone, and adrenal androgens. Each step in the pathway requires specific enzymes. An inherited deficiency in one of these enzymes can alter the balance of hormones and cause precursor substances to accumulate.

More than 90% of CAH cases are associated with 21-hydroxylase deficiency. This enzyme is required for normal cortisol production and also contributes to aldosterone synthesis. When its activity is reduced, 17-hydroxyprogesterone accumulates and is redirected toward androgen production.

17-hydroxyprogesterone is therefore an important screening and monitoring marker for 21-hydroxylase deficiency. A substantially elevated result may support CAH, but mild elevations can occur due to stress, illness, menstrual-cycle timing, prematurity, or other factors.

Androstenedione is an androgen produced by the adrenal glands and gonads. It is a precursor of testosterone and oestrogens. Increased concentrations may reflect excessive adrenal androgen production and can support assessment of CAH severity or treatment control.

Total testosterone measures testosterone bound to proteins and the smaller unbound fraction circulating in blood. Increased testosterone may be associated with adrenal or ovarian androgen excess. Its interpretation depends on age, sex, puberty, menstrual status, and clinical symptoms.

Cortisol is a glucocorticoid involved in the stress response, glucose regulation, blood-pressure maintenance, and inflammation control. Reduced cortisol production is an important feature of classical CAH, but a single cortisol result cannot independently assess adrenal reserve.

Aldosterone helps maintain sodium, potassium, blood pressure, and fluid balance. Severe 21-hydroxylase deficiency may reduce aldosterone production and cause salt wasting. Symptoms can include dehydration, vomiting, low blood pressure, low sodium, and high potassium.

CAH can be classified as classical or non-classical. Classical CAH may present during infancy with genital differences, salt-wasting crisis, or early androgen effects. Non-classical CAH is generally milder and may present later with acne, increased body hair, menstrual irregularity, or fertility concerns.

The panel results must be interpreted together because one abnormal hormone does not establish CAH. Age-specific, sex-specific, and sometimes menstrual-phase-specific reference ranges are important.

If basal 17-hydroxyprogesterone is borderline, the doctor may recommend an ACTH stimulation test. Hormones are measured before and after synthetic ACTH administration to evaluate the adrenal response more clearly.

Additional investigations may include ACTH, renin, sodium, potassium, DHEA-S, genetic testing, adrenal imaging, pelvic ultrasound, or other steroid precursors. Genetic analysis may help confirm the affected enzyme and support family counselling.

For patients receiving glucocorticoid or mineralocorticoid treatment, hormone levels must be interpreted in relation to medicine type, dose, and sample timing. The aim is to control excess androgen production without causing excessive steroid exposure.

At Focus Diagnostics, the CAH Panel is processed using established hormone-analysis methods, controlled sample-handling procedures, and laboratory quality standards to provide reliable results for endocrine interpretation.