Late onset congenital adrenal hyperplasia (LOCAH), also known as nonclassic congenital adrenal hyperplasia (NCCAH or NCAH), is a milder form of congenital adrenal hyperplasia (CAH), a group of autosomal recessive disorders characterized by impaired cortisol synthesis that leads to variable degrees of postnatal androgen excess.The causes of LOCAH are the same as of classic CAH, and in the majority of the cases are the mutations in the CYP21A2 gene resulting in corresponding activity changes in the associated P450c21 (21-hydroxylase) enzyme which ultimately leads to excessive androgen production. Other causes, albeit less frequent, are mutations in genes affecting other enzymes involved in steroid metabolism, like 11β-hydroxylase or 3β-hydroxysteroid dehydrogenase. It has a prevalence between 0.1% and 2% depending on population, and is one of the most common autosomal recessive genetic diseases in humans. The pathophysiology is complex and not all individuals are symptomatic. Presentation
Patients with LOCAH usually present with signs of hyperandrogenism, rather than of glucocorticoid deficiency, a condition characterized by inadequate cortisol production. Cortisol synthesis impairment is mild but clinically silent. LOCAH patients usually have the same baseline but lower peak cortisol levels comparing to healthy controls.
The Talmudic hour is one twelfth of time elapsed from sunrise to sunset, day hours therefore being longer than night hours in the summer; in winter they reverse. The Indic day began at sunrise. The term hora was used to indicate an hour. The time was measured based on the length of the shadow at day time. A hora translated to 2.5 pe. There are 60 pe per day, 60 minutes per pe and 60 kshana (snap of a finger or instant) per minute. Pe was measured with a bowl with a hole placed in still water. Time taken for this graduated bowl was one pe. Kings usually had an officer in charge of this clock. Counting from sunset
In so-called "Italian time", "Italian hours", or "old Czech time", the first hour started with the sunset Angelus bell (or at the end of dusk, i.e., half an hour after sunset, depending on local custom and geographical latitude). The hours were numbered from 1 to 24. For example, in Lugano, the sun rose in December during the 14th hour and noon was during the 19th hour; in June the sun rose during the 7th hour and noon was in the 15th hour. Sunset was always at the end of the 24th hour. The clocks in church towers struck only from 1 to 12, thus only during night or early morning hours. This manner of counting hours had the advantage that everyone could easily know how much time they had to finish their days work without artificial light.