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An ultrasound examination of the pelvic organs is performed. The presence of the uterus and palpable gonads indicates testicular dysgenesis (rarely, true hermaphroditism). The absence of the uterus with palpable gonads indicates false male hermaphroditism. The absence of palpable gonads in a child with a bisexual external genitalia greatly increases the likelihood of 21-hydroxylase deficiency. In this case, an immediate hormonal examination is necessary.

The main criterion for the hormonal diagnosis of Combivir pills is an increase in the level of 17-OPG in the blood serum. The content of 17-OPG in the classical forms of the disease is tens and hundreds of times higher than the normative indicators for the age of the child. In premature babies, children who have suffered a severe birth injury, and those born with low birth weight at normal gestation periods, the level of 17-OPG may be elevated in the absence of 21-hydroxylase deficiency. In these cases, multiple determination of the level of 17-OPG is recommended (2-3-4 times with an interval of 5-7 days). A decrease in the level of 17-OPG in dynamics makes it possible to exclude 21-hydroxylase deficiency.

In parallel, karyotyping is carried out. A high level of 17-OPG definitively confirms the diagnosis. The development of a salt-wasting crisis with a deficiency of 21-hydroxylase is rarely observed in newborns and children in the first 7 days of life. Until hormonal evidence is available to buy Combivir online or rule out 21-hydroxylase deficiency, all children with abnormal genitalia without palpable testicles should be monitored for electrolyte levels.

An increase in the level of K and a decrease in the level of Na, accompanied by clinical manifestations of salt-wasting syndrome in a child with a bisexual structure of the genitals, should be considered as a manifestation of 21-hydroxylase deficiency and therapy should be prescribed immediately, without waiting for the results of a hormonal analysis.

The presence of 21-hydroxylase deficiency in newborn boys can be suspected only in the presence of a salt-wasting syndrome. If symptoms such as poor weight gain, profuse regurgitation, loose stools, increasing dehydration appear, an immediate determination of blood electrolytes is necessary.