In females, hypogonadism can cause sexual infantilism or abnormal pubertal development, infertility, and other reproductive system abnormalities. Genetics
CAH results 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. The most common type (95% of cases) involves the gene for 21-hydroxylase, which is found on 6p21.3 as part of the HLA complex; 21-hydroxylase deficiency results from a unique mutation with two highly homologous near-copies in series consisting of an active gene (CYP21A2) and an inactive pseudogene (CYP21A1P). 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. Other, more rare forms of CAH are caused by mutations in genes, including HSD3B2 (3β-hydroxysteroid dehydrogenase 2), CYP17A1 (17α-hydroxylase/17,20-lyase), CYP11A1 (P450scc; cholesterol side-chain cleavage enzyme), STAR (steroidogenic acute regulatory protein; StAR), CYB5A (cytochrome b5), and CYPOR (cytochrome P450 oxidoreductase; POR). Expressivity
Further variability is introduced by the degree of enzyme inefficiency produced by the specific alleles each patient has. Some alleles result in more severe degrees of enzyme inefficiency. In general, severe degrees of inefficiency produce changes in the fetus and problems in prenatal or perinatal life. Milder degrees of inefficiency are usually associated with excessive or deficient sex hormone effects in childhood or adolescence, while the mildest forms of CAH interfere with ovulation and fertility in adults.
DTaP-IPV/Hib vaccine is a 5-in-1 combination vaccine that protects against diphtheria, tetanus, whooping cough, polio, and Haemophilus influenzae type B.Its generic name is diphtheria and tetanus toxoids and acellular pertussis adsorbed, inactivated poliovirus and haemophilus B conjugate vaccine, and it is also known as DTaP-IPV-Hib. Uses
DTaP-IPV/Hib vaccine is administered to young children to immunise against diphtheria, tetanus, pertussis, poliomyelitis, and diseases caused by Haemophilus influenzae type B.

Formulations
A branded formulation marketed in the United States is Pentacel, manufactured by Sanofi Pasteur.Pentacel is known in the UK and Canada as Pediacel.An equivalent vaccine marketed in the UK and Canada by GlaxoSmithKline is Infanrix IPV + Hib. This is a two-part vaccine. The DTaP-IPV component is supplied as a sterile liquid, which is used to reconstitute lyophilized (freeze-dried) Hib vaccine. Pentaxim is a liquid formulation marketed by Sanofi Pasteur. Availability
It is only licensed for young children. In the US the FDA have approved the vaccine for children from age 6 weeks up to age 5 years. It was used in the UK until 2017, following which a 6-in-1 vaccine became available containing the additional protection against Hepatitis B. == References ==