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Congenital adrenal hyperplasia (CAH) are any of several autosomal recessive diseases resulting from mutations of genes for enzymes mediating the biochemical steps of production of mineralocorticoids, glucocorticoids or sex steroids from cholesterol by the adrenal glands (steroidogenesis).

Each form of CAH is associated with a specific defective gene.

Further variability is introduced by the degree of enzyme inefficiency produced by the specific alleles each patient has.Thirteen international divers and five Thai Navy SEALs were involved in the operation.One volunteer, former Thai Navy SEAL Saman Gunan, died Friday while placing spare air tanks along the escape route. None of the trapped boys had ever been diving before and some didn't even know how to swim.WATCH: All rescued from Thai cave Tuesday's rescue happened on the third consecutive day of efforts to rescue the 12 players and their coach, who have been trapped in the Tham Luang cave complex since late June, a span of more than two weeks.Four boys were rescued Sunday, and another four guided to safety on Monday.Mutant alleles result from recombination between the active and pseudogenes (gene conversion).About 5% of cases of CAH are due to defects in the gene encoding 11β-hydroxylase and consequent 11β-hydroxylase deficiency.Some may present with hyperpigmentation, due to co-secretion with melanocyte-stimulating hormone (MSH), and possible penile enlargement.Age of diagnosis of males with CAH varies and depends on the severity of aldosterone deficiency.CAH due to 21-hydroxylase deficiency is the most common cause of ambiguous genitalia in genotypically normal female infants (44 XX).Less severely affected females may present with early pubarche.

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