Different degrees of virilization in 46,XX infants with congenital adrenal hyperplasia (CAH)

Examples of atypical external genitalia in 46,XX infants with CAH, ranging from mild virilization (Prader II) through severe virilization (Prader IV and V). Other 46,XX infants with CAH can have normal female genitalia (Prader I, not shown). None of these patients has palpable gonads, which is an important clue that CAH should be considered as a diagnosis.
(A) Mild virilization, Prader II.
(B,C) Moderate virilization, Prader III.
(D,E) Severe virilization, Prader IV.
(F) Severe virilization, Prader V, with a complete penile urethra. This is very rare. Prior to the advent of newborn screening for this disorder, affected children may have been identified as male at birth and the diagnosis was made later in childhood.