11β-hydroxylase deficiency medical therapy: Difference between revisions

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{{Congenital adrenal hyperplasia due to 11β-hydroxylase deficiency}}
{{11β-hydroxylase deficiency}}
{{CMG}}; {{AE}} {{Ammu}}
{{CMG}}; {{AE}} {{MJ}}
==Overview==
==Overview==
The mainstay of therapy for congenital adrenal hyperplasia due to 11β-hydroxylase deficiency is glucocorticoid therapy.
Treatment for 11β-hydroxylase deficiency in children is administration of [[glucocorticoids]]. The response to therapy should be monitored by laboratory tests and clinical findings. The treatment option in women is spironolactone. If pregnancy is not desired, [[spironolactone]] plus [[oral contraceptive pills]] can be combined with replacement doses of [[hydrocortisone]]. In adult males, replacement doses of [[hydrocortisone]] should be administered to avoid the development of [[Adrenal tumor|adrenal rest tumors]].
 
==Medical Therapy==
==Medical Therapy==
As with other forms of congenital adrenal hyperplasia, the primary therapy of 11β-hydroxylase deficient congenital adrenal hyperplasia is life long [[glucocorticoid]] replacement in sufficient doses to prevent [[adrenal insufficiency]] and suppress excess mineralocorticoid and androgen production.<ref> Congenital adrenal hyperplasia due to 11β-hydroxylase deficiency. Wikipedia (2016). https://en.wikipedia.org/wiki/Congenital_adrenal_hyperplasia_due_to_11%CE%B2-hydroxylase_deficiency Accessed on January 29, 2016</ref>
* Treatment for 11β-hydroxylase deficiency in children is [[glucocorticoids]] as followings:
* Salt-wasting in infancy responds to intravenous saline, dextrose, and high dose [[hydrocortisone]], but prolonged [[fludrocortisone]] replacement is usually not necessary. The [[hypertension]] is ameliorated by glucocorticoid suppression of DOC.
** Preferred regimen (1): [[Hydrocortisone]] 10 to 25 mg/m2 [[body surface area]]/day PO
* Long term [[glucocorticoid]] replacement requires careful balance between doses sufficient to suppress [[androgen]]s while avoiding suppression of growth. Because the [[enzyme]] defect does not affect [[sex steroid]] synthesis, [[gonads|gonadal]] function at puberty and long-term [[fertility]] should be normal if adrenal androgen production is controlled.
** Preferred regimen (2): [[Hydrocortisone|Prednisolone]]  0.1 mg/kg/day PO
** Preferred regimen (3): [[Dexamethasone]] up to 0.5 mg/day PO
 
* The response to therapy should be monitored by:
** Laboratory tests such as serum [[DHEAS]], [[potassium]] levels, and [[Deoxycortisol|11-deoxycortisol]].
** Clinical findings such [[virilization]], [[growth]] velocity, and [[bone age]].  
* [[Glucocorticoid]]-related side effects such as [[bruising]], [[weight gain]], and [[glucose intolerance]] should be monitored.  
 
* [[Genital]] malformations in females may require surgical correction with one or more surgeries and vaginal dilation.
 
* In women with 11β-hydroxylase deficiency, [[androgen]] excess and [[hypertension]] are indications for treatment. The treatment option in this groups:
** Preferred regimen (1): [[Spironolactone]] 25 to 200 mg/day PO
** If [[pregnancy]] is not desired, [[oral contraceptive pills]] can be combined with [[hydrocortisone]].
 
* In adult males, replacement doses of [[hydrocortisone]] should be administered to avoid the development of [[Adrenal tumor|adrenal rest tumors]].<ref name="pmid28576284">{{cite journal |vauthors=El-Maouche D, Arlt W, Merke DP |title=Congenital adrenal hyperplasia |journal=Lancet |volume= |issue= |pages= |year=2017 |pmid=28576284 |doi=10.1016/S0140-6736(17)31431-9 |url=}}</ref>


==References==
==References==
{{Reflist|2}}
{{Reflist|2}}
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Latest revision as of 16:53, 3 August 2017

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Mehrian Jafarizade, M.D [2]

Overview

Treatment for 11β-hydroxylase deficiency in children is administration of glucocorticoids. The response to therapy should be monitored by laboratory tests and clinical findings. The treatment option in women is spironolactone. If pregnancy is not desired, spironolactone plus oral contraceptive pills can be combined with replacement doses of hydrocortisone. In adult males, replacement doses of hydrocortisone should be administered to avoid the development of adrenal rest tumors.

Medical Therapy

  • Genital malformations in females may require surgical correction with one or more surgeries and vaginal dilation.

References

  1. El-Maouche D, Arlt W, Merke DP (2017). "Congenital adrenal hyperplasia". Lancet. doi:10.1016/S0140-6736(17)31431-9. PMID 28576284.