{"id":2530550,"date":"2021-01-22T20:13:00","date_gmt":"2021-01-23T01:13:00","guid":{"rendered":"https:\/\/myendoconsult.com\/learn\/?p=2530550"},"modified":"2023-03-16T06:16:48","modified_gmt":"2023-03-16T11:16:48","slug":"cah-mnemonic","status":"publish","type":"post","link":"https:\/\/myendoconsult.com\/learn\/cah-mnemonic\/","title":{"rendered":"A mnemonic for CAH"},"content":{"rendered":"<p>Adrenal enzyme deficiencies, specifically congenital adrenal hyperplasia (CAH), and their corresponding effects are frequently tested in board exams (USMLE and ABIM). This is a simple mnemonic for remembering all the critical steps in the adrenal steroid hormone synthesis pathway. I have used this approach to simplify this daunting pathway for medical students and endocrinology fellows.<\/p>\n<h2>The CAH mnemonic<\/h2>\n<ol>\n<li>Remember that all adrenal steroids are synthesized from\u00a0<strong>cholesterol (The StAR of the show).<\/strong><\/li>\n<li>Start with this memory aid \u2014\u00a0<strong>Preg<\/strong>nancy requires\u00a0<strong>Progesterone<\/strong>\u00a0before the\u00a0<strong>DOC<\/strong>tor delivers\u00a0<strong>ALDO<\/strong>sterone in 3, 2, 1\u2026 Write all of the critical steroids and hydroxylases (enzymes) required for mineralocorticoid synthesis in the left column.<\/li>\n<\/ol>\n<p><a href=\"https:\/\/myendoconsult.com\/learn\/wp-content\/uploads\/steroid-synthesis-figure-1-of-3.jpg\" data-elementor-open-lightbox=\"yes\" data-elementor-lightbox-slideshow=\"aa83112\" data-elementor-lightbox-title=\"steroid synthesis figure 1 of 3\"><img loading=\"lazy\" decoding=\"async\" src=\"https:\/\/myendoconsult.com\/learn\/wp-content\/uploads\/steroid-synthesis-figure-1-of-3.jpg\" sizes=\"auto, (max-width: 640px) 100vw, 640px\" srcset=\"https:\/\/myendoconsult.com\/learn\/wp-content\/uploads\/steroid-synthesis-figure-1-of-3.jpg 1219w, https:\/\/myendoconsult.com\/learn\/wp-content\/uploads\/steroid-synthesis-figure-1-of-3-300x225.jpg 300w, https:\/\/myendoconsult.com\/learn\/wp-content\/uploads\/steroid-synthesis-figure-1-of-3-768x576.jpg 768w, https:\/\/myendoconsult.com\/learn\/wp-content\/uploads\/steroid-synthesis-figure-1-of-3-624x468.jpg 624w\" alt=\"\" width=\"640\" height=\"480\" aria-describedby=\"gallery-1-1682099\" \/><\/a>Mineralocorticoid synthesis. steroid synthesis figure 1 of 3<\/p>\n<p>The first part of this memory aid refers to the major steroids in the first layer of the <a href=\"https:\/\/myendoconsult.com\/learn\/mnemonic-for-hormones\/\">adrenal cortex<\/a> (zona glomerulosa) required for mineralocorticoid synthesis.<strong>Preg<\/strong>nancy =\u00a0<strong>Pregnenolone<\/strong><strong>\u2193<\/strong><strong>Progesterone<\/strong>\u00a0= Progesterone\u2193<strong>DOC<\/strong>\u00a0= 11-deoxycorticosterone (11-DOC)\u2193<strong>ALDO\u00a0<\/strong>=\u00a0<strong>Aldo<\/strong>sterone3 = 3-Beta hydroxysteroid dehydrogenase (between Pregnenolone and Progesterone)2 = 21 hydroxylase (between progesterone and 11-DOC)1 = 11-Beta hydroxylase between 11-DOC and Aldosterone)<\/p>\n<p><a href=\"https:\/\/myendoconsult.com\/learn\/wp-content\/uploads\/steroid-synthesis-figure-2-of-3.jpg\" data-elementor-open-lightbox=\"yes\" data-elementor-lightbox-slideshow=\"a76813a\" data-elementor-lightbox-title=\"steroid synthesis figure 2 of 3\"><img loading=\"lazy\" decoding=\"async\" src=\"https:\/\/myendoconsult.com\/learn\/wp-content\/uploads\/steroid-synthesis-figure-2-of-3.jpg\" sizes=\"auto, (max-width: 640px) 100vw, 640px\" srcset=\"https:\/\/myendoconsult.com\/learn\/wp-content\/uploads\/steroid-synthesis-figure-2-of-3.jpg 1237w, https:\/\/myendoconsult.com\/learn\/wp-content\/uploads\/steroid-synthesis-figure-2-of-3-300x226.jpg 300w, https:\/\/myendoconsult.com\/learn\/wp-content\/uploads\/steroid-synthesis-figure-2-of-3-768x579.jpg 768w, https:\/\/myendoconsult.com\/learn\/wp-content\/uploads\/steroid-synthesis-figure-2-of-3-624x471.jpg 624w\" alt=\"\" width=\"640\" height=\"483\" aria-describedby=\"gallery-2-1682193\" \/><\/a>Glucocorticoid synthesis. steroid synthesis figure 2 of 3<\/p>\n<ul>\n<li>The second layer of the adrenal cortex i.e., zona fasciculata, is responsible for the formation of 17 hydroxy steroids. Just change Pregnenolone to 17 hydroxypregnenolone, Progesterone to 17 hydroxyprogesterone, and 11-DOC to 11-Deoxycortisol to arrive at the sequential intermediate steroids required to form cortisol.<\/li>\n<li>The same set of hydroxylases will convert these steroids sequentially in the zona fasciculata.<\/li>\n<li>3 = 3-Beta hydroxysteroid dehydrogenase (between 17 hydroxy Pregnenolone and 17 hydroxy Progesterone)<\/li>\n<li>2 = 21 hydroxylase (between 17 hydroxy Progesterone and 11-Deoxycortisol)<\/li>\n<li>1 = 11-Beta hydroxylase (between 11-Deoxycortisol and Cortisol)<\/li>\n<\/ul>\n<p><a href=\"https:\/\/myendoconsult.com\/learn\/wp-content\/uploads\/steroid-synthesis-3-of-3.jpg\" data-elementor-open-lightbox=\"yes\" data-elementor-lightbox-slideshow=\"b6ef55b\" data-elementor-lightbox-title=\"steroid synthesis 3 of 3\"><img loading=\"lazy\" decoding=\"async\" src=\"https:\/\/myendoconsult.com\/learn\/wp-content\/uploads\/steroid-synthesis-3-of-3.jpg\" sizes=\"auto, (max-width: 640px) 100vw, 640px\" srcset=\"https:\/\/myendoconsult.com\/learn\/wp-content\/uploads\/steroid-synthesis-3-of-3.jpg 1257w, https:\/\/myendoconsult.com\/learn\/wp-content\/uploads\/steroid-synthesis-3-of-3-300x224.jpg 300w, https:\/\/myendoconsult.com\/learn\/wp-content\/uploads\/steroid-synthesis-3-of-3-768x574.jpg 768w, https:\/\/myendoconsult.com\/learn\/wp-content\/uploads\/steroid-synthesis-3-of-3-624x466.jpg 624w\" alt=\"\" width=\"640\" height=\"478\" aria-describedby=\"gallery-3-1682290\" \/><\/a>Sex steroid synthesis. steroid synthesis 3 of 3<\/p>\n<p>The third and final layer of the adrenal cortex, i.e., zona reticularis, is responsible for the formation of 17 ketosteroids. These are the sex steroids. A simple memory aid is that &#8220;<b>SEX <\/b>may occur after a <b>DATE<\/b>&#8220;. DATE refers to the sequential steroids in this final pathway\u2026D (Dehydroepiandrosterone), A (Androstenedione), T (Testosterone), and E (Estradiol)<\/p>\n<h2>References<\/h2>\n<p>Anita H. Payne, Dale B. Hales, Overview of Steroidogenic Enzymes in the Pathway from Cholesterol to Active Steroid Hormones,<a href=\"https:\/\/doi.org\/10.1210\/er.2003-0030\" target=\"_blank\" rel=\"noopener\">\u00a0<em>Endocrine Reviews<\/em>, Volume 25, Issue 6, 1 December 2004, Pages 947\u2013970<\/a><\/p>\n<h2>Images(s) Courtesy<\/h2>\n<p>MyEndoConsult<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Adrenal enzyme deficiencies, specifically congenital adrenal hyperplasia (CAH), and their corresponding effects are frequently tested in board exams (USMLE and ABIM). This is a simple mnemonic for remembering all the critical steps in the adrenal steroid hormone synthesis pathway. I have used this approach to simplify this daunting pathway for medical students and endocrinology fellows. [&hellip;]<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[107],"tags":[],"class_list":["post-2530550","post","type-post","status-publish","format-standard","hentry","category-mnemonics","post-wrapper","thrv_wrapper"],"_links":{"self":[{"href":"https:\/\/myendoconsult.com\/learn\/wp-json\/wp\/v2\/posts\/2530550","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/myendoconsult.com\/learn\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/myendoconsult.com\/learn\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/myendoconsult.com\/learn\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/myendoconsult.com\/learn\/wp-json\/wp\/v2\/comments?post=2530550"}],"version-history":[{"count":35,"href":"https:\/\/myendoconsult.com\/learn\/wp-json\/wp\/v2\/posts\/2530550\/revisions"}],"predecessor-version":[{"id":4416060,"href":"https:\/\/myendoconsult.com\/learn\/wp-json\/wp\/v2\/posts\/2530550\/revisions\/4416060"}],"wp:attachment":[{"href":"https:\/\/myendoconsult.com\/learn\/wp-json\/wp\/v2\/media?parent=2530550"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/myendoconsult.com\/learn\/wp-json\/wp\/v2\/categories?post=2530550"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/myendoconsult.com\/learn\/wp-json\/wp\/v2\/tags?post=2530550"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}