What distinguishes the male salt wasting form of congenital adrenal hyperplasia?

The male salt-wasting form of congenital adrenal hyperplasia (CAH), specifically due to 21-hydroxylase deficiency, is characterized by an inability to produce sufficient aldosterone, which ultimately leads to a loss of sodium and an accumulation of potassium in the blood, causing hyperkalemia.

In this setting, because aldosterone is crucial for sodium retention and potassium excretion, males with this form of CAH do not effectively manage their electrolyte balance, resulting in elevated potassium levels. This is a key manifestation of the disorder and is medically significant, as severe hyperkalemia can lead to life-threatening cardiac arrhythmias and other complications.

The other options refer to features that can be associated with CAH but do not specifically distinguish the male salt-wasting form. For instance, while excess androgens are present in all forms of CAH due to adrenal hyperplasia, and ambiguous genitalia can occur in females due to prenatal exposure to these excess androgens, these features are not exclusive or defining characteristics of the male salt-wasting form. Penile enlargement can also occur, but it is not the primary distinguishing feature of this condition. Thus, hyperkalemia stands out as the hallmark condition that defines the male (and female)