in this video I'm going to be talking about the congenital adrenal enzyme deficiencies this is brought to you by dirty medicine now I know what you're thinking Oh dirty no not the adrenal enzymes relax we are not gonna need to refer to this diagram I'm putting this here because this is probably what jumped into your brain right as soon as I said adrenal enzymes you probably thought oh my god I need some finally memorize that stupid enzyme flow chart that you see on this slide that I always skip through in all of my review textbooks and in all my question banks well that's the truth guys you absolutely don't need to know this and unless you're gonna be an endocrinologist or a very very very nerdy maybe even PhD level internal medicine doctor there's really no point in memorizing this so throw it out of your brain take that piece of paper that has this on it crumble it up throw it in the toilet and flush that puppy because you don't need to know this instead what I'm gonna focus on is what you do need to know and what you need to know specifically for all the steps and levels of USMLE and comlex now if you flip through first aid or whatever review textbook you're using you'll probably notice that there are normally three major adrenal enzyme deficiencies that get mentioned and only two of those are really particularly high-yield and those are shown on this slide the 21 hydroxylation efficiency and the 17 alpha hydroxylase deficiency the other one is very low yield and I don't recommend that you commit it to memory unless you have some extra brain space lying over at the end of this lecture but for all intents and purposes what I think you should take away from this video it's how to differentiate 21 hydroxylation deficiency from 17 alpha hydroxylase deficiency and specifically what the test writers are going to expect you to know and what's actually pretty high yield is being able to discern what happens to the mineralocorticoids what happens to the sex hormones what happens to the blood pressure the sodium and the potassium in each of these two disease states now if you feel slightly overwhelmed right now because you're looking at this chart and you already don't quite understand the adrenal enzyme deficiencies and now you're seeing all these things that you need to know that I'm telling you are high-yield I want you to relax because of the way that you're gonna learn this if you watch my video today is with a pretty awesome mnemonic it is so simple you just tell yourself a little story and you'll learn all of this information in no time so the way that my pneumonic works is that I need you to imagine somebody who just wants to go to college all they want to do is go to college and the way that we're gonna use this pneumonic is that we're gonna look at the 21 hydroxylase deficiency and take the number 21 out and that'll be our 21 year old and then we'll look at the 17 alpha hydroxylase deficiency and take the number 17 out and have a 17 year old so in this story you've got a 21 year old college student and a 17 year old high school student and remember the goal is to go to college everybody wants to go to college so here's how I'm gonna set up this mnemonic for you so we've got our 21 year old and he's happy as a clam right because he's in college he made it he gets to study learned once learned what he wants to learn go out and party with his friends he's living it up he's happy but our 17 year old high school student he is miserable because he's still stuck in high school and all he wants to do is go to college so here we go we've got our 21 year old who's in college and very happy and our 17 year old who's not in college yet so he's pretty upset now what does this mean well when you're 21 you're in college you're manly right you've made it you're a senior in college you're manly so that that stands for increased sex hormones for the 21 year old but the 17 year old he's not manly yet because he's still a little baby he's in high school his voice probably still cracks to be honest with you so in the 21 hydroxylation sufficiency there's increased sex hormones because when you're 21 and in college you're manly but in the seventeen hydroxylase deficiency that's the 17 alpha hydroxylase deficiency there's decreased sex hormones because you're still in high school you're not manly yet so 21 in college manly increased sex hormones 17 still in high school not manly yet decreased sex hormones now let's move on so we talked about sex hormones and now let's talk about mineralocorticoids so because the 21 year old is really happy he's not salty and because the 17 year old is really up set he is salty so you know we we say that you're really salty if you're really angry and upset and pissy so the 21 hydroxylase deficiency is not salty which is to say that there's decreased mineralocorticoids because the mineralocorticoid is aldosterone and that is responsible for salt so in the 21 hydroxylase deficiency we've got a 21 year old student really happy and therefore not salty so there's decreased mineralocorticoids but in the 17 alpha hydroxylase deficiency the student who's still in high school and so upset that he's not in college yet he's really salty so there's increased levels of mineralocorticoids now if you have a little bit of background knowledge about what a mineral accord equate is right we're talking about aldosterone you should know what aldosterone does in the body aldosterone increases sodium increases blood pressure and decreases potassium so in our 21 hydroxylase deficiency where there's decreased mineralocorticoids also known as decreased aldosterone that means that there's decreased sodium and therefore decreased blood pressure and increased potassium so in our 21 year old college student who is not salty and therefore does not have aldosterone or has decreased aldosterone there's decreased sodium increased potassium and decreased blood pressure but in the 17 alpha hydroxylation deficiency it's a 17 year old very salty high school student right he's salty he just wants to go to college so that means there's increased levels of mineralocorticoids which is increased aldosterone and what happens when aldosterone is up well sodium is up and therefore blood pressure is up and potassium is down so just by taking the numbers out of the two deficiencies right 21 out of 21 hydroxylase and 17 out of 17 alpha hydroxylase and creating the stupid mnemonic the stupid story that I made up years ago the 21 year old is happy because he's in college but the 17 year olds pissed off because he's still in high school and just wants to go to college by doing that by extracting those numbers you can learn everything you need to know to differentiate the two adrenal enzyme deficiencies so go through this story one more time and make sure that it really hits home in your brain and that you can understand it because once you do it's really easy to fill in this chart and let's just prove it to you by running through the story one more time so we've got two main adrenal enzyme deficiencies the 21 hydroxylase deficiency which will in our story be the happy 21 year-old who's already in college because he's 21 and the 17 alpha hydroxylase deficiency which is our 17 year old and when you're 17 you're usually not yet at college so you're still stuck in high school and you're pretty upset because you're still in high school and you just want to go to college so the 21 year old he's in college he's manly and therefore his sex hormones are up but the 17 year old you know he's still a little babe he's in high school his voice might still be cracking he's learning how to talk to women he's still discovering himself so the sex hormones are gonna be down in the 17 alpha hydroxylase deficiency now because her 21 year old is really happy he's not salty so he has decreased levels of salt so mineralocorticoids are down which means aldosterone is down and if aldosterone is down that means that sodium and therefore blood pressure are both down but potassium is up but in the seventeen-year-old he's so salty because he just wants to go to college he's like why the hell am I still in high school and because he's salty his salt or his mineralocorticoids or his aldosterone are up and if aldosterone is up then sodium and by extension blood pressure are both up but potassium is down so that's it guys if you use the dirty medicine stupid mnemonic and just look at the numbers 21 vs. 17 you can figure out everything that you need to know based on the fact that the 21 year old is happy because he's in college and the 17 year old is a salty little high schooler that's all I know that it's stupid I know that I went through it fast but if you know this story you're not gonna get the questions wrong that wants you to differentiate between these two good luck