Hashimoto's disease is an autoimmune disorder affecting the thyroid gland. The thyroid is a butterfly-shaped gland located at the base of the neck just below the Adam's apple. The thyroid produces hormones that help regulate many functions in the body. An autoimmune disorder is an illness caused by the immune system attacking healthy tissues. In Hashimoto's disease, immune-system cells lead to the death of the thyroid's hormone-producing cells. The disease usually results in a decline in hormone production (hypothyroidism). Although anyone can develop Hashimoto's disease, it's most common among middle-aged women. The primary treatment is thyroid hormone replacement. Hashimoto's disease is also known as Hashimoto's thyroiditis, chronic lymphocytic thyroiditis and chronic autoimmune thyroiditis. Thyroid gland The thyroid gland is located at the base of the neck, just below the Adam's apple. Symptoms Hashimoto's disease progresses slowly over the years. You may not notice signs or symptoms of the disease. Eventually, the decline in thyroid hormone production can result in any of the following: Fatigue and sluggishness Increased sensitivity to cold Increased sleepiness Dry skin Constipation Muscle weakness Muscle aches, tenderness and stiffness Joint pain and stiffness Irregular or excessive menstrual bleeding Depression Problems with memory or concentration Swelling of the thyroid (goiter) A puffy face Brittle nails Hair loss Enlargement of the tongue When to see a doctor Signs and symptoms of Hashimoto's disease vary widely and are not specific to the disorder. Because these symptoms could result from any number of disorders, it's important to see your health care provider as soon as possible for a timely and accurate diagnosis. Causes Hashimoto's disease is an autoimmune disorder. The immune system creates antibodies that attack thyroid cells as if they were bacteria, viruses or some other foreign body. The immune system wrongly enlists disease-fighting agents that damage cells and lead to cell death. What causes the immune system to attack thyroid cells is not clear. The onset of disease may be related to: Genetic factors Environmental triggers, such as infection, stress or radiation exposure Interactions between environmental and genetic factors Risk factors The following factors are associated with an increased risk of Hashimoto's disease: Sex. Women are much more likely to get Hashimoto's disease. Age. Hashimoto's disease can occur at any age but more commonly occurs during middle age. Other autoimmune disease. Having another autoimmune disease — such as rheumatoid arthritis, type 1 diabetes or lupus — increases your risk of developing Hashimoto's disease. Genetics and family history. You're at higher risk for Hashimoto's disease if others in your family have thyroid disorders or other autoimmune diseases. Pregnancy. Typical changes in immune function during pregnancy may be a factor in Hashimoto's disease that begins after pregnancy. Excessive iodine intake. Too much iodine in the diet may function as a trigger among people already at risk for Hashimoto's disease. Radiation exposure. People exposed to excessive levels of environmental radiation are more prone to Hashimoto's disease. Complications Thyroid hormones are essential for the healthy function of many body systems. Therefore, when Hashimoto's disease and hypothyroidism are left untreated, many complications can occur. These include: Goiter. A goiter is enlargement of the thyroid. As thyroid hormone production declines due to Hashimoto's disease, the thyroid receives signals from the pituitary gland to make more. This cycle may result in a goiter. It's generally not uncomfortable, but a large goiter can affect your appearance and may interfere with swallowing or breathing. Heart problems. Hypothyroidism can result in poor heart function, an enlarged heart and irregular heartbeats. It can also result in high levels of low-density lipoprotein (LDL) cholesterol — the "bad" cholesterol — that is a risk factor for cardiovascular disease and heart failure. Mental health issues. Depression or other mental health disorders may occur early in Hashimoto's disease and may become more severe over time. Sexual and reproductive dysfunction. In women, hypothyroidism can result in a reduced sexual desire (libido), an inability to ovulate, and irregular and excessive menstrual bleeding. Men with hypothyroidism may have a reduced libido, erectile dysfunction and a lowered sperm count. Poor pregnancy outcomes. Hypothyroidism during pregnancy may increase the risk of a miscarriage or preterm birth. Babies born to women with untreated hypothyroidism are at risk for decreased intellectual abilities, autism, speech delays and other developmental disorders. Myxedema (miks-uh-DEE-muh). This rare, life-threatening condition can develop due to long-term, severe, untreated hypothyroidism. Its signs and symptoms include drowsiness followed by profound lethargy and unconsciousness. A myxedema coma may be triggered by exposure to cold, sedatives, infection or other stress on your body. Myxedema requires immediate emergency medical treatment.

Graves' disease is an immune system condition that affects the thyroid gland. It causes the body to make too much thyroid hormone. That condition is called hyperthyroidism. Thyroid hormones affect many organs in the body. So Graves' disease symptoms also can affect those organs. Anyone can get Graves' disease. But it's more common in women and in people older than 30. Treatment for Graves' disease helps lower the amount of thyroid hormone that the body makes and eases symptoms. Symptoms Common symptoms of Graves' disease include: Feeling nervous and irritable. Having a slight tremor of the hands or fingers. Being sensitive to heat with an increase in sweating or warm, moist skin. Losing weight, despite wanting to eat more. Having an enlarged thyroid gland, also called goiter. Having changes in menstrual cycles. Not being able to get or keep an erection, called erectile dysfunction, or having less desire for sex. Having bowel movements often. Having bulging eyes — a condition called thyroid eye disease or Graves' ophthalmopathy. Being tired. Having thick, discolored skin mostly on the shins or tops of the feet, called Graves' dermopathy. Having fast or irregular heartbeat, called palpitations. Not sleeping well. Thyroid eye disease Thyroid eye disease also is called Graves' ophthalmopathy. About 25% of people with Graves' disease have eye symptoms. Thyroid eye disease affects muscles and other tissues around the eyes. Symptoms may include: Bulging eyes. A gritty feeling in the eyes. Pressure or pain in the eyes. Puffy eyelids or eyelids that don't cover the eyeball all the way. This is called retracted eyelids. Red or inflamed eyes. Light sensitivity. Blurred or double vision. Vision loss. Graves' dermopathy Rarely, people with Graves' disease have darkening and thickening of the skin. It most often appears on the shins or the tops of the feet. The skin has a texture like an orange peel. This is called Graves' dermopathy. It comes from a buildup of protein in the skin. It's most often mild and painless. When to see a doctor Other medical conditions can cause symptoms like those of Graves' disease. See your healthcare professional if you have any symptoms of Graves' disease to get a prompt diagnosis. Seek medical care right away if you have heart-related symptoms, such as a fast or irregular heartbeat, or if you have vision loss. Causes Graves' disease is caused by the body's disease-fighting immune system not working correctly. Experts don't know why this happens. The immune system makes antibodies that target viruses, bacteria or other foreign substances. In Graves' disease, the immune system makes an antibody to one part of the cells in the hormone-making gland in the neck, called the thyroid gland. A tiny gland at the base of the brain, called the pituitary gland, makes a hormone that controls the thyroid gland. The antibody linked with Graves' disease is called thyrotropin receptor antibody (TRAb). TRAb takes over the work of the pituitary hormone. That leads to more thyroid hormone in the body than the body needs. That condition is called hyperthyroidism. Cause of thyroid eye disease Thyroid eye disease, also called Graves' ophthalmopathy, comes from a buildup of certain carbohydrates in the muscles and tissues behind the eyes. The cause isn't known. It may involve the same antibody that can cause the thyroid gland to not work correctly. Thyroid eye disease often appears at the same time as hyperthyroidism or several months later. But symptoms of thyroid eye disease can appear years before or after hyperthyroidism starts. It's also possible to have thyroid eye disease without hyperthyroidism. Risk factors Factors that can increase the risk of Graves' disease include: Family history. People who get Graves' disease often have a family history of thyroid conditions or an autoimmune condition. Sex. Women are much more likely to get Graves' disease than are men. Age. Graves' disease mostly happens between the ages of 30 and 60. Another autoimmune condition. People with other conditions of the immune system, such as type 1 diabetes or rheumatoid arthritis, have a higher risk. Smoking. Cigarette smoking, which can affect the immune system, raises the risk of Graves' disease. People who smoke and have Graves' disease are at higher risk of getting thyroid eye disease. Complications Complications of Graves' disease can include: Pregnancy health concerns. Graves' disease during pregnancy can cause miscarriage, early birth, fetal thyroid issues and poor fetal growth. It also can cause heart failure and preeclampsia in the pregnant person. Preeclampsia leads to high blood pressure and other serious symptoms. Heart conditions. Graves' disease that isn't treated can lead to irregular heart rhythms and changes in the heart and how it works. The heart might not be able to pump enough blood to the body. That condition is called heart failure. Thyroid storm. This rare but deadly complication of Graves' disease also is called accelerated hyperthyroidism or thyrotoxic crisis. It's more likely to happen when severe hyperthyroidism is not treated or not treated well enough. Thyroid storm happens when a sudden and drastic rise in thyroid hormones causes a number of effects in the body. They include fever, sweating, confusion, delirium, severe weakness, tremors, irregular heartbeat, severe low blood pressure and coma. Thyroid storm needs medical attention right away. Brittle bones. Hyperthyroidism that isn't treated can lead to weak, brittle bones — a condition called osteoporosis. The strength of the bones depends, in part, on the amount of calcium and other minerals they hold. Too much thyroid hormone makes it hard for the body to get calcium into the bones.

A goiter (GOI-tur) is the irregular growth of the thyroid gland. The thyroid is a butterfly-shaped gland located at the base of the neck just below the Adam's apple. A goiter may be an overall enlargement of the thyroid, or it may be the result of irregular cell growth that forms one or more lumps (nodules) in the thyroid. A goiter may be associated with no change in thyroid function or with an increase or decrease in thyroid hormones. Enlarged thyroid Widespread enlargement of the thyroid can expand the gland well beyond its typical size (left) and cause a noticeable bulge in the neck (right). The most common cause of goiters worldwide is a lack of iodine in the diet. In the United States, where the use of iodized salt is common, goiters are caused by conditions that change thyroid function or factors that affect thyroid growth. Treatment depends on the cause of the goiter, symptoms, and complications resulting from the goiter. Small goiters that aren't noticeable and don't cause problems usually don't need treatment. Symptoms Most people with goiters have no signs or symptoms other than a swelling at the base of the neck. In many cases, the goiter is small enough that it's only discovered during a routine medical exam or an imaging test for another condition. Other signs or symptoms depend on whether thyroid function changes, how quickly the goiter grows and whether it obstructs breathing. Underactive thyroid (hypothyroidism) Signs and symptoms of hypothyroidism include: Fatigue Increased sensitivity to cold Increased sleepiness Dry skin Constipation Muscle weakness Problems with memory or concentration Overactive thyroid (hyperthyroidism) Signs and symptoms of hyperthyroidism include: Weight loss Rapid heartbeat (tachycardia) Increased sensitivity to heat Excess sweating Tremors Irritability and nervousness Muscle weakness Frequent bowel movements Changes in menstrual patterns Sleep difficulty High blood pressure Increased appetite Children with hyperthyroidism might also have the following: Rapid growth in height Changes in behavior Bone growth that outpaces expected growth for the child's age Obstructive goiter The size or position of a goiter may obstruct the airway and voice box. Signs and symptoms may include: Difficulty swallowing Difficulty breathing with exertion Cough Hoarseness Snoring Causes How the thyroid gland works Two hormones produced by the thyroid are thyroxine (T-4) and triiodothyronine (T-3). When the thyroid releases thyroxine (T-4) and triiodothyronine (T-3) into the bloodstream, they play a role in many functions in the body, including the regulation of: The conversion of food into energy (metabolism) Body temperature Heart rate Blood pressure Other hormone interactions Growth during childhood The thyroid gland also produces calcitonin, a hormone that helps regulate the amount of calcium in the blood. Pituitary gland and hypothalamus The pituitary gland and the hypothalamus are located within the brain and control hormone production. How the thyroid is regulated The pituitary gland and hypothalamus control the rate at which T-4 and T-3 are produced and released. The hypothalamus is a specialized region at the base of the brain. It acts as a thermostat for maintaining balance in multiple body systems. The hypothalamus signals the pituitary gland to make a hormone known as thyroid-stimulating hormone (TSH). The pituitary gland — located below the hypothalamus — releases a certain amount of thyroid-stimulating hormone (TSH), depending on how much T-4 and T-3 are in the blood. The thyroid gland, in turn, regulates its production of hormones based on the amount of TSH it receives from the pituitary gland. Causes of goiter A number of factors that influence thyroid function or growth can result in a goiter. Iodine deficiency. Iodine is essential for the production of thyroid hormones. If a person does not get enough dietary iodine, hormone production drops and the pituitary gland signals the thyroid to make more. This increased signal results in thyroid growth. In the United States, this cause is uncommon because of iodine added to table salt. Hashimoto's disease. Hashimoto's disease is an autoimmune disorder, an illness caused by the immune system attacking healthy tissues. The damaged and inflamed tissues of the thyroid don't produce enough hormones (hypothyroidism). When the pituitary gland detects the decline and prompts the thyroid to create more hormones, the thyroid can become enlarged. Graves' disease. Another autoimmune disorder called Graves' disease occurs when the immune system produces a protein that mimics TSH. This rogue protein prompts the thyroid to overproduce hormones (hyperthyroidism) and can result in thyroid growth. Thyroid nodules. A nodule is the irregular growth of thyroid cells that form a lump. A person may have one nodule or several nodules (multinodular goiter). The cause of nodules is not clear, but there may be multiple factors — genetics, diet, lifestyle and environment. Most thyroid nodules are noncancerous (benign). Thyroid cancer. Thyroid cancer is less common than other cancers and generally treatable. About 5% of people with thyroid nodules are found to have cancer. Pregnancy. A hormone produced during pregnancy, human chorionic gonadotropin (HCG), may cause the thyroid gland to be overactive and enlarge slightly. Inflammation. Thyroiditis is inflammation of the thyroid caused by an autoimmune disorder, bacterial or viral infection, or medication. The inflammation may cause hyperthyroidism or hypothyroidism. Thyroid nodules Enlargement of the thyroid can expand the gland well beyond its typical size and cause a noticeable bulge in the neck. This can be caused by single or multiple nodules (lumps) in the thyroid or by an autoimmune process. Risk factors Anyone can develop a goiter. It may be present at birth or occur at any time throughout life. Some common risk factors for goiters include: A lack of dietary iodine. Iodine is found primarily in seawater and in the soil in coastal areas. In the developing world in particular, people who don't have enough iodine in their diets or access to food supplemented with iodine are at increased risk. This is rare in the United States. Being female. Women are more likely to develop a goiter or other thyroid disorders. Pregnancy and menopause. Thyroid problems in women are more likely to occur during pregnancy and menopause. Age. Goiters are more common after age 40. Family medical history. Family medical history of goiters or other thyroid disorders increases the risk of goiters. Also, researchers have identified genetic factors that may be associated with an increased risk. Medications. Some medical treatments, including the heart drug amiodarone (Pacerone) and the psychiatric drug lithium (Lithobid), increase your risk. Radiation exposure. Your risk increases if you've had radiation treatments to your neck or chest area. Complications A goiter itself usually doesn't cause complications. The appearance may be troublesome or embarrassing for some people. A large goiter may obstruct the airway and voice box. Changes in the production of thyroid hormones that may be associated with goiters have the potential for causing complications in multiple body systems.

Gestational diabetes is diabetes diagnosed for the first time during pregnancy (gestation). Like other types of diabetes, gestational diabetes affects how your cells use sugar (glucose). Gestational diabetes causes high blood sugar that can affect your pregnancy and your baby's health. While any pregnancy complication is concerning, there's good news. During pregnancy you can help control gestational diabetes by eating healthy foods, exercising and, if necessary, taking medication. Controlling blood sugar can keep you and your baby healthy and prevent a difficult delivery. If you have gestational diabetes during pregnancy, generally your blood sugar returns to its usual level soon after delivery. But if you've had gestational diabetes, you have a higher risk of getting type 2 diabetes. You'll need to be tested for changes in blood sugar more often. Symptoms Most of the time, gestational diabetes doesn't cause noticeable signs or symptoms. Increased thirst and more-frequent urination are possible symptoms. When to see a doctor If possible, seek health care early — when you first think about trying to get pregnant — so your health care provider can check your risk of gestational diabetes along with your overall wellness. Once you're pregnant, your health care provider will check you for gestational diabetes as part of your prenatal care. If you develop gestational diabetes, you may need checkups more often. These are most likely to occur during the last three months of pregnancy, when your health care provider will monitor your blood sugar level and your baby's health. Causes Researchers don't yet know why some women get gestational diabetes and others don't. Excess weight before pregnancy often plays a role. Usually, various hormones work to keep blood sugar levels in check. But during pregnancy, hormone levels change, making it harder for the body to process blood sugar efficiently. This makes blood sugar rise. Risk factors Risk factors for gestational diabetes include: Being overweight or obese Not being physically active Having prediabetes Having had gestational diabetes during a previous pregnancy Having polycystic ovary syndrome Having an immediate family member with diabetes Having previously delivered a baby weighing more than 9 pounds (4.1 kilograms) Being of a certain race or ethnicity, such as Black, Hispanic, American Indian and Asian American Complications Gestational diabetes that's not carefully managed can lead to high blood sugar levels. High blood sugar can cause problems for you and your baby, including an increased likelihood of needing a surgery to deliver (C-section). Complications that may affect your baby If you have gestational diabetes, your baby may be at increased risk of: Excessive birth weight. If your blood sugar level is higher than the standard range, it can cause your baby to grow too large. Very large babies — those who weigh 9 pounds or more — are more likely to become wedged in the birth canal, have birth injuries or need a C-section birth. Early (preterm) birth. High blood sugar may increase the risk of early labor and delivery before the due date. Or early delivery may be recommended because the baby is large. Serious breathing difficulties. Babies born early may experience respiratory distress syndrome — a condition that makes breathing difficult. Low blood sugar (hypoglycemia). Sometimes babies have low blood sugar (hypoglycemia) shortly after birth. Severe episodes of hypoglycemia may cause seizures in the baby. Prompt feedings and sometimes an intravenous glucose solution can return the baby's blood sugar level to normal. Obesity and type 2 diabetes later in life. Babies have a higher risk of developing obesity and type 2 diabetes later in life. Stillbirth. Untreated gestational diabetes can result in a baby's death either before or shortly after birth. Complications that may affect you Gestational diabetes may also increase your risk of: High blood pressure and preeclampsia. Gestational diabetes raises your risk of high blood pressure, as well as preeclampsia — a serious complication of pregnancy that causes high blood pressure and other symptoms that can threaten both your life and your baby's life. Having a surgical delivery (C-section). You're more likely to have a C-section if you have gestational diabetes. Future diabetes. If you have gestational diabetes, you're more likely to get it again during a future pregnancy. You also have a higher risk of developing type 2 diabetes as you get older. Prevention There are no guarantees when it comes to preventing gestational diabetes — but the more healthy habits you can adopt before pregnancy, the better. If you've had gestational diabetes, these healthy choices may also reduce your risk of having it again in future pregnancies or developing type 2 diabetes in the future. Eat healthy foods. Choose foods high in fiber and low in fat and calories. Focus on fruits, vegetables and whole grains. Strive for variety to help you achieve your goals without compromising taste or nutrition. Watch portion sizes. Keep active. Exercising before and during pregnancy can help protect you from developing gestational diabetes. Aim for 30 minutes of moderate activity on most days of the week. Take a brisk daily walk. Ride your bike. Swim laps. Short bursts of activity — such as parking further away from the store when you run errands or taking a short walk break — all add up. Start pregnancy at a healthy weight. If you're planning to get pregnant, losing extra weight beforehand may help you have a healthier pregnancy. Focus on making lasting changes to your eating habits that can help you through pregnancy, such as eating more vegetables and fruits. Don't gain more weight than recommended. Gaining some weight during pregnancy is typical and healthy. But gaining too much weight too quickly can increase your risk of gestational diabetes. Ask your health care provider what a reasonable amount of weight gain is for you.

Gender dysphoria is a feeling of distress that can happen when a person's gender identity differs from the sex assigned at birth. Some transgender and gender-diverse people have gender dysphoria at some point in their lives. Other transgender and gender-diverse people feel at ease with their bodies and gender identities, and they don't have gender dysphoria. A diagnosis for gender dysphoria is included in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). The DSM-5 is published by the American Psychiatric Association. The diagnosis was created to help people with gender dysphoria get access to the healthcare and treatment that they need. A diagnosis of gender dysphoria focuses on the feeling of distress as the issue, not gender identity. Symptoms Gender identity is having the internal sense of being male or female or being somewhere along the gender spectrum, or having an internal sense of gender that is beyond male and female. People who have gender dysphoria feel a big difference between their gender identity and their sex assigned at birth. Gender dysphoria is different from simply not following stereotypical gender behaviors. It involves feelings of distress due to a strong, lasting desire to be another gender. Gender dysphoria might start in childhood and continue into the teen years and adulthood. But some people may have periods of time in which they don't notice gender dysphoria. Or the feelings may seem to come and go. Some people have gender dysphoria when puberty starts. In others, it may not develop until later in life. Some teens might express their feelings of gender dysphoria to their parents or a healthcare professional. But others might have symptoms of a mood disorder, anxiety or depression instead. Or they might have social difficulties or problems in school. Complications Gender dysphoria can affect many parts of life, including daily activities. For example, school might be hard for people with gender dysphoria. That may be due to pressure to dress or act in a way that's linked to their sex assigned at birth. Being harassed, teased or bullied due to gender identity also can make it very challenging to do well in school. If gender dysphoria makes school or work very hard, the result may be dropping out of school or not being able to find a job. Gender dysphoria can pose problems within relationships. Anxiety, depression, self-harm, eating disorders, substance misuse and other mental health concerns can happen too. People who have gender dysphoria often are the targets of discrimination and prejudice. That can lead to ongoing stress and fear. This is called gender minority stress. Accessing healthcare services and mental health services may be hard. This can be due to a lack of insurance coverage, being refused care, trouble finding a healthcare professional with expertise in transgender care or fear of discrimination in healthcare settings. People with gender dysphoria who don't receive the support and treatment they need are at higher risk of thinking about or attempting suicide.

Erectile dysfunction means not being able to get and keep an erection firm enough for sexual activity. It also is called impotence. Having erection trouble from time to time isn't always a cause for concern. But if erectile dysfunction is ongoing, it can cause stress, affect self-confidence and add to challenges with a partner. Problems getting or keeping an erection can be a sign of a health condition that needs treatment and a risk factor for heart disease. If you're worried about erectile dysfunction, talk to your healthcare professional, even if it's awkward. Sometimes, treating an underlying condition can fix erectile dysfunction. Or you might need medicines or other direct treatments. Having trouble getting an erection once in a while is common. Erectile dysfunction symptoms are ongoing and often get worse over time. They might include: Trouble getting an erection. Trouble keeping an erection. Wanting sex less. When to see a doctor Your main healthcare professional is a good place to start when you have erectile issues. See your healthcare professional if: You worry about your erections or you have other sexual problems, such as ejaculating sooner than you want. This is called premature ejaculation. Ejaculating later than you want is called delayed ejaculation. You have diabetes, heart disease or another health condition that might be linked to erectile dysfunction. You have other symptoms with erectile dysfunction. Causes Male sexual arousal is complex. It involves the brain, hormones, emotions, nerves, muscles and blood vessels. Erectile dysfunction can result from a problem with any of these. Also, stress and mental health concerns can cause erectile dysfunction or make it worse. Sometimes the cause of erectile dysfunction is both physical and mental. For instance, a minor physical condition that slows your sexual response might cause worry about keeping an erection. The anxiety can add to erectile dysfunction. Physical causes of erectile dysfunction Common physical causes of erectile dysfunction include: Heart disease. Clogged blood vessels, also called atherosclerosis. High cholesterol. High blood pressure. Diabetes. Obesity. Metabolic syndrome, which involves higher blood pressure, high insulin levels, body fat around the waist and high cholesterol. Parkinson's disease. Multiple sclerosis. Certain prescription medicines Tobacco use. Peyronie's disease, which can cause pain during sex, a bent penis to bend, a penis that gets shorter with erection or a lump or bump in the penis. Overuse of alcohol and use of illicit drugs. Sleep conditions. Treatments for prostate cancer or enlarged prostate. Surgeries or injuries that affect the pelvic area or spinal cord. Low levels of the hormone testosterone. Mental health causes of erectile dysfunction The brain plays a key role in getting sexually excited, which starts an erection. Things that can get in the way of sexual feelings and cause or add to erectile dysfunction include: Depression, anxiety or other mental health conditions. Stress. Issues with a partner. Risk factors As you get older, erections might take longer to start and might not be as firm. You might need more direct touch to your penis to get and keep an erection. But erectile dysfunction is not a typical part of aging. Risk factors that can add to erectile dysfunction include: Medical conditions. Diabetes or heart conditions are big risk factors. Tobacco use. This lowers blood flow to veins and arteries. Over time, tobacco use can cause ongoing health conditions that lead to erectile dysfunction. Being overweight. Being obese, especially, can lead to erectile dysfunction. Certain medical treatments. These include prostate surgery or radiation treatment for cancer. Injuries. This is especially true if injuries damage the nerves or arteries that control erections. Medicines. These include antidepressants, antihistamines, and medicines to treat high blood pressure, pain or prostate conditions. Mental health conditions. These include stress, anxiety and depression. Illicit drug and alcohol use. This is especially true for long-term drug use or heavy drinking. Complications Complications from erectile dysfunction can include: A poor sex life. Depression, stress or anxiety. Embarrassment or low self-esteem. Relationship issues. Not being able to get your partner pregnant.

Galactorrhea (guh-lack-toe-REE-uh) is a milky nipple discharge not linked to the making of milk for breastfeeding. Galactorrhea isn't a disease. But it can be a sign of an underlying condition. Galactorrhea mostly happens to people assigned female at birth. It can happen even to those who haven't had children or who have gone through menopause. But galactorrhea also can happen to people assigned male at birth and even to infants. Too much breast handling, medicine side effects or conditions of the pituitary gland may add to galactorrhea. Often, higher levels of the hormone involved in making breast milk, called prolactin, cause galactorrhea. Sometimes, the cause of galactorrhea can't be found. The condition may clear up on its own. Symptoms Symptoms linked to galactorrhea include: Milky nipple discharge that's constant or comes and goes. Nipple discharge from more than one milk duct. Nipple discharge that leaks on its own or when the breast is touched. Nipple discharge from one or both breasts. Irregular or no menstrual periods. Headaches or trouble with vision. When to see a doctor If one or both breasts keep leaking milky discharge, and you're not pregnant or breastfeeding, make an appointment to see your healthcare professional. If breast stimulation, such as handling the nipple during sex, causes nipple discharge from more than one duct, there's little cause for worry. The discharge most often doesn't mean there's a problem. And the discharge often clears up on its own. If you keep having discharge that doesn't go away, make an appointment with your healthcare professional. Nipple discharge that isn't milky needs medical attention right away. If the discharge is bloody, or clear and comes from one duct or there's a lump you can feel, it may be a sign of breast cancer. Galactorrhea often results from having too much of the hormone that makes milk when you have a baby. This is called prolactin. Your pituitary gland, a small bean-shaped gland at the base of your brain involved with several hormones, makes prolactin. Possible causes of galactorrhea include: Medicines, such as certain sedatives, antidepressants, antipsychotics and high blood pressure medicines. Opioid use. Herbal supplements, such as fennel, anise or fenugreek seed. Birth control pills. A noncancerous pituitary tumor, called prolactinoma, or other condition of the pituitary gland. Underactive thyroid, also called hypothyroidism. Long-term kidney disease. Too much handling of the breast. This may be linked with sex activity, having breast self-exams with nipple handling or long-lasting rubbing from clothing. Nerve damage to the chest wall from chest surgery, burns or other chest injuries. Spinal cord surgery, injury or tumors. Stress. Idiopathic galactorrhea Sometimes healthcare professionals can't find a cause for galactorrhea. This is called idiopathic galactorrhea. This may mean that the breast tissue is very sensitive to the milk-making hormone prolactin. If so, even typical prolactin levels can lead to galactorrhea. Galactorrhea in males In people assigned male at birth, galactorrhea may be linked with too little of the hormone testosterone. Called male hypogonadism, this most often also causes breasts that are enlarged or tender, called gynecomastia. Not being able to get and keep an erection, called erectile dysfunction, and not wanting to have sex also are linked with too little testosterone. Risk factors Anything that triggers the release of the hormone prolactin can increase the risk of galactorrhea. Risk factors include: Certain medicines, illicit drugs and herbal supplements. Conditions that affect the pituitary gland, such as pituitary tumors that aren't cancer. Certain medical conditions, such as long-term kidney disease, spinal cord injury, injuries to the chest wall and underactive thyroid. A lot of touching and rubbing of the breasts. Stress.

End-stage renal disease, also called end-stage kidney disease or kidney failure, occurs when chronic kidney disease — the gradual loss of kidney function — reaches an advanced state. In end-stage renal disease, your kidneys no longer work as they should to meet your body's needs. Your kidneys filter wastes and excess fluids from your blood, which are then excreted in your urine. When your kidneys lose their filtering abilities, dangerous levels of fluid, electrolytes and wastes can build up in your body. With end-stage renal disease, you need dialysis or a kidney transplant to stay alive. But you can also choose to opt for conservative care to manage your symptoms — aiming for the best quality of life during your remaining time. Symptoms Early in chronic kidney disease, you might have no signs or symptoms. As chronic kidney disease progresses to end-stage renal disease, signs and symptoms might include: Nausea Vomiting Loss of appetite Fatigue and weakness Changes in how much you urinate Chest pain, if fluid builds up around the lining of the heart Shortness of breath, if fluid builds up in the lungs Swelling of feet and ankles High blood pressure (hypertension) that's difficult to control Headaches Difficulty sleeping Decreased mental sharpness Muscle twitches and cramps Persistent itching Metallic taste Signs and symptoms of kidney disease are often nonspecific, meaning they can also be caused by other illnesses. Because your kidneys can make up for lost function, signs and symptoms might not appear until irreversible damage has occurred. When to seek care Make an appointment with your health care provider if you have signs or symptoms of kidney disease. If you have a medical condition that increases your risk of kidney disease, your care provider is likely to monitor your kidney function with urine and blood tests and your blood pressure during regular office visits. Ask your provider whether these tests are necessary for you. Kidney disease occurs when a disease or condition impairs kidney function, causing kidney damage to worsen over several months or years. For some people, kidney damage can continue to progress even after the underlying condition is resolved. Diseases and conditions that can lead to kidney disease include: Type 1 or type 2 diabetes High blood pressure Glomerulonephritis (gloe-mer-u-low-nuh-FRY-tis) — an inflammation of the kidney's filtering units (glomeruli) Interstitial nephritis (in-tur-STISH-ul nuh-FRY-tis), an inflammation of the kidney's tubules and surrounding structures Polycystic kidney disease or other inherited kidney diseases Prolonged obstruction of the urinary tract, from conditions such as enlarged prostate, kidney stones and some cancers Vesicoureteral (ves-ih-koe-yoo-REE-tur-ul) reflux, a condition that causes urine to back up into your kidneys Recurrent kidney infection, also called pyelonephritis (pie-uh-low-nuh-FRY-tis) Risk factors Certain factors increase the risk that chronic kidney disease will progress more quickly to end-stage renal disease, including: Diabetes with poor blood sugar control Kidney disease that affects the glomeruli, the structures in the kidneys that filter wastes from the blood Polycystic kidney disease High blood pressure Tobacco use Black, Hispanic, Asian, Pacific Islander or American Indian heritage Family history of kidney failure Older age Frequent use of medications that could be damaging to the kidney Complications Kidney damage, once it occurs, can't be reversed. Potential complications can affect almost any part of your body and can include: Fluid retention, which could lead to swelling in your arms and legs, high blood pressure, or fluid in your lungs (pulmonary edema) A sudden rise in potassium levels in your blood (hyperkalemia), which could impair your heart's ability to function and may be life-threatening Heart disease Weak bones and an increased risk of bone fractures Anemia Decreased sex drive, erectile dysfunction or reduced fertility Damage to your central nervous system, which can cause difficulty concentrating, personality changes or seizures Decreased immune response, which makes you more vulnerable to infection Pericarditis, an inflammation of the saclike membrane that envelops your heart (pericardium) Pregnancy complications that carry risks for the mother and the developing fetus Malnutrition Irreversible damage to your kidneys (end-stage kidney disease), eventually requiring either dialysis or a kidney transplant for survival Prevention If you have kidney disease, you may be able to slow its progress by making healthy lifestyle choices: Achieve and maintain a healthy weight Be active most days Limit protein and eat a balanced diet of nutritious, low-sodium foods Control your blood pressure Take your medications as prescribed Have your cholesterol levels checked every year Control your blood sugar level Don't smoke or use tobacco products Get regular checkups

Diabetic nephropathy is a serious complication of type 1 diabetes and type 2 diabetes. It's also called diabetic kidney disease. In the United States, about 1 in 3 people living with diabetes have diabetic nephropathy. Diabetic nephropathy affects the kidneys' usual work of removing waste products and extra fluid from the body. The best way to prevent or delay diabetic nephropathy is by living a healthy lifestyle and keeping diabetes and high blood pressure managed. Over years, diabetic nephropathy slowly damages the kidneys' filtering system. Early treatment may prevent this condition or slow it and lower the chance of complications. Diabetic kidney disease can lead to kidney failure. This also is called end-stage kidney disease. Kidney failure is a life-threatening condition. Treatment options for kidney failure are dialysis or a kidney transplant. Symptoms In the early stages of diabetic nephropathy, there might not be symptoms. In later stages, symptoms may include: High blood pressure that gets harder to control. Swelling of feet, ankles, hands or eyes. Foamy urine. Confusion or difficulty thinking. Shortness of breath. Loss of appetite. Nausea and vomiting. Itching. Tiredness and weakness. When to see a doctor Make an appointment with your health care professional if you have symptoms of kidney disease. If you have diabetes, visit your health care professional yearly or as often as you're told for tests that measure how well your kidneys are working. Causes Diabetic nephropathy happens when diabetes damages blood vessels and other cells in the kidneys. The kidneys have millions of tiny blood vessel clusters called glomeruli. Glomeruli filter waste from the blood. Damage to these blood vessels can lead to diabetic nephropathy. The damage can keep the kidneys from working as they should and lead to kidney failure. Diabetic nephropathy causes Diabetic nephropathy is a common complication of type 1 and type 2 diabetes. Over time, diabetes that isn't well controlled can damage blood vessels in the kidneys that filter waste from the blood. This can lead to kidney damage and cause high blood pressure. High blood pressure can cause more kidney damage by raising the pressure in the filtering system of the kidneys. Risk factors If you have diabetes, the following can raise your risk of diabetic nephropathy: Uncontrolled high blood sugar, also called hyperglycemia. Uncontrolled high blood pressure, also called hypertension. Smoking. High blood cholesterol. Obesity. A family history of diabetes and kidney disease. Complications Complications of diabetic nephropathy can come on slowly over months or years. They may include: Body fluid buildup. This could lead to swelling in the arms and legs, high blood pressure, or fluid in the lungs, called pulmonary edema. A rise in the levels of the mineral potassium in the blood, called hyperkalemia. Heart and blood vessel disease, also called cardiovascular disease. This could lead to a stroke. Fewer red blood cells to carry oxygen. This condition also is called anemia. Pregnancy complications that carry risks for the pregnant person and the growing fetus. Damage to the kidneys that can't be fixed. This is called end-stage kidney disease. Treatment is either dialysis or a kidney transplant. Prevention To lower your risk of developing diabetic nephropathy: See your health care team regularly to manage diabetes. Keep appointments to check on how well you are managing your diabetes and to check for diabetic nephropathy and other complications. Your appointments might be yearly or more often. Treat your diabetes. With good treatment of diabetes, you can keep your blood sugar levels in the target range as much as possible. This may prevent or slow diabetic nephropathy. Manage high blood pressure or other medical conditions. If you have high blood pressure or other conditions that raise your risk of kidney disease, work with your health care professional to control them. Take medicines you get without a prescription only as directed. Read the labels on the pain relievers you take. This might include aspirin and nonsteroidal anti-inflammatory drugs, such as naproxen sodium (Aleve) and ibuprofen (Advil, Motrin IB, others). For people with diabetic nephropathy, these types of pain relievers can lead to kidney damage. Stay at a healthy weight. If you're at a healthy weight, work to stay that way by being physically active most days of the week. If you need to lose weight, talk with a member of your health care team about the best way for you to lose weight. Don't smoke. Cigarette smoking can damage kidneys or make kidney damage worse. If you're a smoker, talk to a member of your health care team about ways to quit. Support groups, counseling and some medicines might help.

Diabetes mellitus refers to a group of diseases that affect how the body uses blood sugar (glucose). Glucose is an important source of energy for the cells that make up the muscles and tissues. It's also the brain's main source of fuel. The main cause of diabetes varies by type. But no matter what type of diabetes you have, it can lead to excess sugar in the blood. Too much sugar in the blood can lead to serious health problems. Chronic diabetes conditions include type 1 diabetes and type 2 diabetes. Potentially reversible diabetes conditions include prediabetes and gestational diabetes. Prediabetes happens when blood sugar levels are higher than normal. But the blood sugar levels aren't high enough to be called diabetes. And prediabetes can lead to diabetes unless steps are taken to prevent it. Gestational diabetes happens during pregnancy. But it may go away after the baby is born. Symptoms Diabetes symptoms depend on how high your blood sugar is. Some people, especially if they have prediabetes, gestational diabetes or type 2 diabetes, may not have symptoms. In type 1 diabetes, symptoms tend to come on quickly and be more severe. Some of the symptoms of type 1 diabetes and type 2 diabetes are: Feeling more thirsty than usual. Urinating often. Losing weight without trying. Presence of ketones in the urine. Ketones are a byproduct of the breakdown of muscle and fat that happens when there's not enough available insulin. Feeling tired and weak. Feeling irritable or having other mood changes. Having blurry vision. Having slow-healing sores. Getting a lot of infections, such as gum, skin and vaginal infections. Type 1 diabetes can start at any age. But it often starts during childhood or teen years. Type 2 diabetes, the more common type, can develop at any age. Type 2 diabetes is more common in people older than 40. But type 2 diabetes in children is increasing. When to see a doctor If you think you or your child may have diabetes. If you notice any possible diabetes symptoms, contact your health care provider. The earlier the condition is diagnosed, the sooner treatment can begin. If you've already been diagnosed with diabetes. After you receive your diagnosis, you'll need close medical follow-up until your blood sugar levels stabilize. Causes To understand diabetes, it's important to understand how the body normally uses glucose. How insulin works Insulin is a hormone that comes from a gland behind and below the stomach (pancreas). The pancreas releases insulin into the bloodstream. The insulin circulates, letting sugar enter the cells. Insulin lowers the amount of sugar in the bloodstream. As the blood sugar level drops, so does the secretion of insulin from the pancreas. The role of glucose Glucose — a sugar — is a source of energy for the cells that make up muscles and other tissues. Glucose comes from two major sources: food and the liver. Sugar is absorbed into the bloodstream, where it enters cells with the help of insulin. The liver stores and makes glucose. When glucose levels are low, such as when you haven't eaten in a while, the liver breaks down stored glycogen into glucose. This keeps your glucose level within a typical range. The exact cause of most types of diabetes is unknown. In all cases, sugar builds up in the bloodstream. This is because the pancreas doesn't produce enough insulin. Both type 1 and type 2 diabetes may be caused by a combination of genetic or environmental factors. It is unclear what those factors may be. Risk factors Risk factors for diabetes depend on the type of diabetes. Family history may play a part in all types. Environmental factors and geography can add to the risk of type 1 diabetes. Sometimes family members of people with type 1 diabetes are tested for the presence of diabetes immune system cells (autoantibodies). If you have these autoantibodies, you have an increased risk of developing type 1 diabetes. But not everyone who has these autoantibodies develops diabetes. Race or ethnicity also may raise your risk of developing type 2 diabetes. Although it's unclear why, certain people — including Black, Hispanic, American Indian and Asian American people — are at higher risk. Prediabetes, type 2 diabetes and gestational diabetes are more common in people who are overweight or obese. Complications Long-term complications of diabetes develop gradually. The longer you have diabetes — and the less controlled your blood sugar — the higher the risk of complications. Eventually, diabetes complications may be disabling or even life-threatening. In fact, prediabetes can lead to type 2 diabetes. Possible complications include: Heart and blood vessel (cardiovascular) disease. Diabetes majorly increases the risk of many heart problems. These can include coronary artery disease with chest pain (angina), heart attack, stroke and narrowing of arteries (atherosclerosis). If you have diabetes, you're more likely to have heart disease or stroke. Nerve damage from diabetes (diabetic neuropathy). Too much sugar can injure the walls of the tiny blood vessels (capillaries) that nourish the nerves, especially in the legs. This can cause tingling, numbness, burning or pain that usually begins at the tips of the toes or fingers and gradually spreads upward. Damage to the nerves related to digestion can cause problems with nausea, vomiting, diarrhea or constipation. For men, it may lead to erectile dysfunction. Kidney damage from diabetes (diabetic nephropathy). The kidneys hold millions of tiny blood vessel clusters (glomeruli) that filter waste from the blood. Diabetes can damage this delicate filtering system. Eye damage from diabetes (diabetic retinopathy). Diabetes can damage the blood vessels of the eye. This could lead to blindness. Foot damage. Nerve damage in the feet or poor blood flow to the feet increases the risk of many foot complications. Skin and mouth conditions. Diabetes may leave you more prone to skin problems, including bacterial and fungal infections. Hearing impairment. Hearing problems are more common in people with diabetes. Alzheimer's disease. Type 2 diabetes may increase the risk of dementia, such as Alzheimer's disease. Depression related to diabetes. Depression symptoms are common in people with type 1 and type 2 diabetes. Complications of gestational diabetes Most women who have gestational diabetes deliver healthy babies. However, untreated or uncontrolled blood sugar levels can cause problems for you and your baby. Complications in your baby can be caused by gestational diabetes, including: Excess growth. Extra glucose can cross the placenta. Extra glucose triggers the baby's pancreas to make extra insulin. This can cause your baby to grow too large. It can lead to a difficult birth and sometimes the need for a C-section. Low blood sugar. Sometimes babies of mothers with gestational diabetes develop low blood sugar (hypoglycemia) shortly after birth. This is because their own insulin production is high. Type 2 diabetes later in life. Babies of mothers who have gestational diabetes have a higher risk of developing obesity and type 2 diabetes later in life. Death. Untreated gestational diabetes can lead to a baby's death either before or shortly after birth. Complications in the mother also can be caused by gestational diabetes, including: Preeclampsia. Symptoms of this condition include high blood pressure, too much protein in the urine, and swelling in the legs and feet. Gestational diabetes. If you had gestational diabetes in one pregnancy, you're more likely to have it again with the next pregnancy. Prevention Type 1 diabetes can't be prevented. But the healthy lifestyle choices that help treat prediabetes, type 2 diabetes and gestational diabetes can also help prevent them: Eat healthy foods. Choose foods lower in fat and calories and higher in fiber. Focus on fruits, vegetables and whole grains. Eat a variety to keep from feeling bored. Get more physical activity. Try to get about 30 minutes of moderate aerobic activity on most days of the week. Or aim to get at least 150 minutes of moderate aerobic activity a week. For example, take a brisk daily walk. If you can't fit in a long workout, break it up into smaller sessions throughout the day. Lose excess pounds. If you're overweight, losing even 7% of your body weight can lower the risk of diabetes. For example, if you weigh 200 pounds (90.7 kilograms), losing 14 pounds (6.4 kilograms) can lower the risk of diabetes. But don't try to lose weight during pregnancy. Talk to your provider about how much weight is healthy for you to gain during pregnancy. To keep your weight in a healthy range, work on long-term changes to your eating and exercise habits. Remember the benefits of losing weight, such as a healthier heart, more energy and higher self-esteem. Sometimes drugs are an option. Oral diabetes drugs such as metformin (Glumetza, Fortamet, others) may lower the risk of type 2 diabetes. But healthy lifestyle choices are important. If you have prediabetes, have your blood sugar checked at least once a year to make sure you haven't developed type 2 diabetes.

Cystic fibrosis (CF) is a condition passed down in families that causes damage to the lungs, digestive system and other organs in the body. CF affects the cells that make mucus, sweat and digestive juices. These fluids, also called secretions, are usually thin and slippery to protect the body's internal tubes and ducts and make them smooth pathways. But in people with CF, a changed gene causes the secretions to become sticky and thick. The secretions plug up pathways, especially in the lungs and pancreas. CF gets worse over time and needs daily care, but people with CF usually can attend school and work. They often have a better quality of life than people with CF had in past decades. Better screening and treatments mean that people with CF now may live into their mid- to late 50s or longer, and some are being diagnosed later in life. Symptoms In the U.S., because of newborn screening, cystic fibrosis can be diagnosed within the first month of life, before symptoms develop. But people born before newborn screening became available may not be diagnosed until the symptoms of CF show up. CF symptoms vary, depending on which organs are affected and how severe the condition is. Even in the same person, symptoms may worsen or get better at different times. Some people may not have symptoms until their teenage years or adulthood. People who are not diagnosed until adulthood usually have milder symptoms and are more likely to have symptoms that aren't typical. These may include repeated bouts of an inflamed pancreas called pancreatitis, infertility and repeated bouts of pneumonia. People with CF have a higher than usual level of salt in their sweat. Parents often can taste the salt when they kiss their children. Most of the other symptoms of CF affect the respiratory system and digestive system. Respiratory symptoms In cystic fibrosis, the lungs are most commonly affected. The thick and sticky mucus that happens with CF clogs the tubes that carry air in and out of the lungs. This can cause symptoms such as: A cough that won't go away and brings up thick mucus. A squeaking sound when breathing called wheezing. Limited ability to do physical activity before tiring. Repeated lung infections. Irritated and swollen nasal passages or a stuffy nose. Repeated sinus infections. Digestive symptoms The thick mucus caused by cystic fibrosis can block tubes that carry digestive enzymes from the pancreas to the small intestine. Without these digestive enzymes, the intestines can't completely take in and use the nutrients in food. The result is often: Foul-smelling, greasy stools. Poor weight gain and growth. Blocked intestines, which is more likely to happen in newborns. Ongoing or severe constipation. Straining often while trying to pass stool can cause part of the rectum to stick out of the anus. This is called a rectal prolapse. When to see a doctor If you or your child has symptoms of cystic fibrosis — or if someone in your family has CF — talk with your healthcare professional about testing for the condition. Make an appointment with a doctor who has skills and experience in treating CF. CF requires regular follow-up with your healthcare professional, at least every three months. Call your healthcare professional if you have new or worsening symptoms, such as more mucus than usual or a change in the mucus color, lack of energy, weight loss, or severe constipation. Get medical care right away if you're coughing up blood, have chest pain or trouble breathing, or have severe stomach pain and bloating. Call 911 or your local emergency number or go to the emergency department at a hospital if: You're having a hard time catching your breath or talking. Your lips or fingernails turn blue or gray. Others notice that you're not mentally alert.

Congenital adrenal hyperplasia (CAH) is the medical name for a group of genetic conditions that affect the adrenal glands. The adrenal glands are a pair of walnut-sized organs above the kidneys. They make important hormones, including: Cortisol. This controls the body's response to illness or stress. Mineralocorticoids such as aldosterone. These control sodium and potassium levels. Androgens such as testosterone. These sex hormones are needed for growth and development in both males and females. In people with CAH, a gene change results in a lack of one of the enzyme proteins needed to make these hormones. The two major types of congenital adrenal hyperplasia are: Classic CAH. This type is rarer and more serious. It's usually found by tests at birth or in early infancy. Nonclassic CAH. This type is milder and more common. It may not be found until childhood or early adulthood. There is no cure for congenital adrenal hyperplasia. But with proper treatment, most people who have CAH can lead full lives. Symptoms Symptoms of CAH vary. The symptoms depend on which gene is affected. They also depend on how greatly the adrenal glands lack one of the enzymes needed to make hormones. With CAH, the hormones that the body needs to work properly are thrown out of balance. That may lead to too little cortisol, too little aldosterone, too many androgens or a mix of these issues. Classic CAH Symptoms of classic CAH can include: Not enough cortisol. With classic CAH, the body doesn't make enough of the hormone cortisol. This can cause problems keeping blood pressure, blood sugar and energy at healthy levels. It also can cause problems during physical stress such as illness. Adrenal crisis. People with classic CAH can be seriously affected by a lack of cortisol, aldosterone or both. This is known as an adrenal crisis. It can be life-threatening. External genitals that don't look typical. In female infants, some parts of the genitals on the outside of the body may look different than usual. For instance, the clitoris may be enlarged and resemble a penis. The labia may be partly closed and look like a scrotum. The tube through which urine leaves the body and the vagina may be one opening instead of two separate openings. The uterus, fallopian tubes and ovaries often develop in a typical manner. Male infants with CAH often have genitals that look typical but sometimes are enlarged. Too much androgen. An excess of the male sex hormone androgen can lead to short height and early puberty for children. Pubic hair and other signs of puberty may appear at a very early age. Serious acne also may occur. Extra androgen hormones in females may lead to facial hair, more body hair than usual and a deeper voice. Altered growth. Children may grow fast. And their bones could be more developed than is typical for their age. Final height may be shorter than average. Fertility issues. These can include irregular menstrual periods or not having periods at all. Some women with classic CAH may have trouble becoming pregnant. Fertility issues sometimes can occur in men. Nonclassic CAH Often, there are no symptoms of nonclassic CAH when a baby is born. Some people with nonclassic CAH never have symptoms. The condition is not found on routine infant blood screening tests. If symptoms occur, they usually appear in late childhood or early adulthood. Females who have nonclassic CAH may have genitals that look typical at birth. Later in life, they may have: Irregular menstrual periods, or none at all. Trouble getting pregnant. Features such as facial hair, more body hair than usual and a deeper voice. Sometimes, nonclassic CAH may be confused with a hormonal condition that happens during the reproductive years called polycystic ovary syndrome. Nonclassic CAH symptoms in children of either birth sex also can include: Symptoms of early puberty, such as growth of pubic hair sooner than usual. Serious acne. Rapid growth during childhood with bones that are more developed than is typical. Shorter than expected final height. When to see a doctor Most often, classic CAH is found at birth through routine newborn screening tests. Or it's found when a baby's outer genitals do not look typical. CAH also may be detected when infants show symptoms of serious illness due to low levels of cortisol, aldosterone or both. In children who have nonclassic CAH, symptoms of early puberty may appear. If you have concerns about your child's growth or development, schedule a checkup with your child's healthcare professional. In older people who have irregular periods, trouble getting pregnant or both, screening for CAH may be appropriate. If you are planning pregnancy or are pregnant and may be at risk of CAH, ask your healthcare professional about genetic counseling. A genetic counselor can tell you if your genes might affect you or any children you decide to have. Causes The most common cause of CAH is the lack of the enzyme protein known as 21-hydroxylase. Sometimes, CAH is called 21-hydroxylase deficiency. The body needs this enzyme to make proper amounts of hormones. Very rarely, a lack of other much rarer enzymes also can cause CAH. CAH is a genetic condition. That means it's passed from parents to children. It's present at birth. Children with the condition have two parents who both carry the genetic change that causes CAH. Or they have two parents who have CAH themselves. This is known as the autosomal recessive inheritance pattern. People can carry the CAH gene and not have symptoms of the condition. This is called being a silent carrier. If a silent carrier becomes pregnant, that person can pass the gene to a child. If tests show that you're a silent carrier of the CAH gene and you have a partner of the opposite sex, talk with your healthcare professional. It's likely that your partner will need to get tested for the CAH gene before pregnancy so that you can better understand the risks. Risk factors Factors that raise the risk of having CAH include: Parents who both have CAH. Parents who are both carriers of the changed gene that causes CAH. Being of Ashkenazi Jewish, Latino, Mediterranean, Yugoslav or Yup'ik descent. Complications People who have classic CAH are at risk of a life-threatening condition called adrenal crisis. This emergency needs to be treated right away. Adrenal crisis can happen within the first few days after birth. It also can be triggered at any age by an infectious illness or physical stress such as surgery. With adrenal crisis, very low levels of cortisol in the blood can cause: Diarrhea. Vomiting. Dehydration. Confusion. Low blood sugar levels. Seizures. Shock. Coma. Aldosterone also may be low. This leads to dehydration, low sodium and high potassium levels. The nonclassic form of CAH doesn't cause adrenal crisis. People who have either classic or nonclassic CAH may have irregular menstrual cycles and fertility issues. Prevention There is no known way to prevent CAH. If you're thinking of starting a family and you're at risk of having a child with CAH, talk with your healthcare professional. You may be told to see a genetic counselor.