Question

question 14

referring to the cpt® codebook in the evocative/suppression subsection, if a patient has congenital adrenal hypoplasia (cah) and testing is performed to identify if the insufficiency is due to 21 hydroxylase deficiency (insufficient stimulating hormones or inability to react to those hormones), what substances are tested for and how many times must the tests be performed?

cortisol x 2, 17 hydroxyprogesterone x 2
estradiol x 2
adrenocorticotropic hormone (acth) x 6
aldosterone x 2, renin x 2

Explanation:

Identify the relevant CPT panel for 21-hydroxylase deficiency

Under the Evocative/Suppression Testing subsection of the CPT codebook, the panel specifically designed to evaluate congenital adrenal hyperplasia (CAH) due to 21-hydroxylase deficiency is the "Corticotropin releasing hormone (CRH) stimulation panel" or the "ACTH stimulation panel" variants. Specifically, the panel for 21-hydroxylase deficiency requires testing of Cortisol and 17-Hydroxyprogesterone.

Determine the substances and frequency of testing

The CPT guidelines for this specific evocative/suppression panel require:

• Cortisol \(\times\) 2
• 17-Hydroxyprogesterone \(\times\) 2

Answer:

• (A) Cortisol x 2, 17 Hydroxyprogesterone x 2 (Correct answer)
• (B) Estradiol x 2
• (C) Adrenocorticotropic hormone (ACTH) x 6
• (D) Aldosterone x 2, Renin x 2