shixx279: November 2011 Archives

How much do you know about CAH?

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What is CAH?
CAH is congenital adrenal hyperlasia, which is a inherited syndrome due to insufficient adrenal. It appears approximately 1 in 15,000 births. There are two kinds of CAH: one is classical CAH, the other is non-classical CAH. Classical CAH could cause uncontrolled salt and fluids loss from body, leading to adrenal crisis and death.On the other hand, non-classical CAH does no threat life, but affect quality of patients' life.CAH.gif
What causes CAH?
The cause of CAH is gene for producing vital adrenal cortex hormones mutating during coding process.The researches show that a lack of enzyme 21- hydroxylase causes around 95% CAH diseases. It catalyzes hydroxylation reaction and add -OH on the carbon atom 21 in steroids, which is a necessary formation process for hormones.
As a normal human, our adrenal produces produce two kinds of hormones: cortisol and aldosterone. Corticosteroid-biosynthetic-pathway-rat.png
Deficiency of 21-hydroxylase enzyme can lead to disruption due to imbalance of these hormones. For instance, if low level of cortisol, aldosterone overproduces androgens or male steroid hormones into high level.Trimethyl_steroid-nomenclature.png
Classical CAH and Nonclassical CAH
Classical CAH could cause adrenal crises with dehydration and shock, even death. Therefore, patients with classical CAH must be treated properly. In early fetal life, abnormal adrenal androgen production causes abnormal growth of clitoris in girls and masculinzation of other genital-urinary structure. Thus girls patients may be mistaken for boy birth and boys patients have unusually fast body growth when androgen overproduces continually. Patients with classical CAH are premature with shorter height compare to normal adults.
But people affected by nonclassical CAH only develop public hair prematurely and unwanted body hair, or with irregular menstrual periods.
From statistics, there are about 10% to 15% young women with nonclassical CAH suffer fertility problems.Autosomal_R_I1.gif
Treatment of CAH
Proper medical treatment for classical CAH uses glucocorticoids to balance amounts of two hormones to permit near-normal growth and puberty. Another medicine called mineralocorticoids is used to balance salt level and prevent adrenal crisis. Th surgical treatment is that reconstructs near-normal female genital and vagina at the same time as they reduce the size of the clitoris in early infancy. The surgeons have two stages and finish late adolescent period. For nonclassical CAH, individuals can be treated with very low dose glucocorticoids, which is optional and temporary.

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As we known, children are affected a lot when their parents decide to divorce. But the degree of influences and the factors contributed in divorcing families have not discussed in the textbook.
Are there any damages for children of divorce?
According to Amato and Keith's studies in 1991, children from divorced families, on average, experience more difficulty in school and getting along with their parents, than children in married two-parent families. Also, they may have more negative self-concepts. However, Amato mentioned that the actual difference between these two groups have more similarities than differences. Other studies replicate same results.These findings illustrate that most of children from divorced families do not have serious problems compare to children from intact families, but more children from divorced families tend to need help than intact family children.Emotional-Effects-of-Divorce-Children.jpg
Why children in divorced versus intact families are still different?
Paul Amato and Kelly conclude 6 factors that may contribute to difficulties of children in divorced: Parental loss, economic loss, more life stress, poor parental adjustment, lack of parental competence and exposure to conflict between parents. Parents provide emotional support and practical assistance, even serve as role models for their children. The quantity of the father-child relationships is the determining factor for their children growing; limited economic resources makes that children from divorced have more difficulties than intact families, because schools, friends and other supportive relationships change. Parental competence is skills that parents have dealing with children have profound influence on children's well-being. The evidence in studies suggest that parenting skills and types of relationships between parent and child are strong influences on how well children are doing.
Some researches show that children carry more painful memories and longer than children given chances to voice their ideas about visiting or living arrangements. Because they feel little control over their lies following divorce including the transition between households.divorce.jpg
Therefore, divorce may affect children but not very much, and the degree of influences mainly depend on the loss of contact with parents, economic difficulties, stress, parental adjustment and competence.

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