The late presentation of steroid 5?-reductase-2 (SRD5A2) deficiency in females is poorly characterised. The ratios of 5?/5?-reduced metabolites of adrenal steroids in a urine steroid profile (USP) can give an indication of SRD5A2 deficiency, although the diagnostic cut-off for 5?/5? ratios are not clearly defined in genetically confirmed cases.