This is a real-world medical entrance exam question, please give the true answer based on the question and selection. Topic name: None, Subject name: Pediatrics
[{'content': 'An 8 days old male infant is brought to the emergency department with vomiting, lethargy, dehydration and features of shock. Clinical examination reveals hyperpigmentation of the genital skin and normal external genitalia. Abdominal examination is unremarkable. blood tests revealed sodium of 124 mecill, potassium of 7 meq/1 and hypoglycemia. Which of the following is the most likely diagnosis: \nSelect and explain. \nA. Congenital Adrenal FIyperplasia (CAH), B. Adrenal Haemorrhage, C. Acute Gastorenteritis with dehydration, D. Hyperaldosteronism', 'role': 'user'}, {'content': 'Answer: A \nExplanation: Presence of vomiting, lethargy, dehydration, hyponatremia, hyperkalemia, hypoglycemia and shock in this eight-year-old male infant suggest a diagnosis of neonatal adrenal insufficiency/crisis.\nCongenital Adrenal Hyperplasia is the most prevalent cause of adrenal insufficiency in neonates (typically 7-14 days post delivery) and the single best answer amongst the options provided,\nClinical features of CAH (21 hydroxylase deficiency) \n\nSymptoms of classical CAH due to 21 hydroxylase deficiency are:\n\n\nClinical: Lethargy, vomiting, Anorexia, weight loss, dehydration, hypotension, shock\nMineralocorticoid deficiency: Hyponatremia, hyperkalemia, hypotension\nCortisol deficiency: Hypoglycemia, Hyperpigmentation of areolar and scrotal areas in males and genital creases in females (due to ↑ ACTH secretion)\nExcess Androgen\n\n\nMales: Phenotypically normal for some years, precocious puberty\nFemales: Virilization (female pseudohermaphrodite)', 'role': 'assistant'}]