MANAGEMENT OF ENDOCRINE DISEASE: Congenital adrenal hyperplasia due to 21-hydroxylase deficiency: update in management of adult patients and prenatal treatment

Congenital adrenal hyperplasia (CAH) due to 21-hydroxylase deficiency is characterized by cortisol and in some cases aldosterone deficiency associated with androgen excess. Goals of treatment are to replace deficient hormones and control androgen excess, while avoiding the adverse effects of exogenous glucocorticoid (GC). Over the last 5 years, cohorts of adults with CAH due to 21hydroxylase deficiency from Europe and the United States have been described, allowing us to have a better knowledge of long-term complications of the disease and its treatment. Patients with CAH have increased mortality, morbidity and risk for infertility and metabolic disorders. These comorbidities are due in part to the drawbacks of the currently available glucocorticoid therapy. Consequently, novel therapies are being developed and studied in an attempt to improve patient outcomes. New management strategies in the care of pregnancies at risk for congenital adrenal hyperplasia using fetal sex determination and dexamethasone have also been described, but remain a subject of debate. We focused the present overview on the data published in the last 5 years, concentrating on studies dealing with cardiovascular risk, fertility, treatment and prenatal management in adults with classic CAH, to provide the reader with an updated review on this rapidly evolving field of knowledge.

European journal of endocrinology. 2017 Jan 23 [Epub ahead of print]

Anne Bachelot, Virginie Grouthier, Carine Courtillot, Jerome Dulon, Philippe Touraine

A Bachelot, Endocrinology, Groupe Hospitalier Pitié-Sapêtrière, Paris, 75013, France., V Grouthier, Endocrinology and Reproductive Medicine, Hopitaux Universitaires Pitie Salpetriere-Charles Foix, Paris, France., C Courtillot, Endocrinology and Reproductive Medicine, Hopitaux Universitaires Pitie Salpetriere-Charles Foix, Paris, France., J Dulon, Department of Endocrinology and Reproductive Medicine, AP-HP, IE3M, UPMC Univ Paris 06, Paris, France., P Touraine, Endocrinology and Reproductive Medicine, Groupe Hospitalier Pitié-Sapêtrière, Paris, France .