In classic CAH due to 21-hydroxylase deficiency, which combination of hormone production occurs?

• A. Deficient cortisol; excess aldosterone and decreased androgens.
• B. Deficient aldosterone; excess cortisol.
• C. Deficient cortisol and aldosterone with excess androgen production.
• D. Excess cortisol with normal aldosterone and androgens.

Answer: (C)

In classic CAH from 21-hydroxylase deficiency, the block in the adrenal steroid pathway reduces production of both cortisol and aldosterone, while precursors are shunted into androgen synthesis. So cortisol and aldosterone are deficient, and androgens are elevated due to increased ACTH drive and enzyme block. This combination—deficient cortisol and aldosterone with excess androgens—best fits the scenario.

The other patterns don’t match: aldosterone is not increased (it’s decreased), cortisol is not in excess (it’s deficient), and androgens are not normal.