21-hydroxylase deficiency medical therapy: Difference between revisions

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====Optimizing growth in congenital adrenal hyperplasia====
====Optimizing growth in congenital adrenal hyperplasia====
*[[Glucocorticoids]] are essential for health and dosing is always a matter of approximation. In even mildly excessive dose, glucocorticoids can slow growth.
*[[Glucocorticoids]] are essential for health and dosing is always a matter of approximation. In even mildly excessive dose, glucocorticoids can slow growth.<ref name="Wikipeadia"> https://en.wikipedia.org/wiki/Congenital_adrenal_hyperplasia_due_to_21-hydroxylase_deficiency</ref><ref name="pmid11344936">{{cite journal| author=Migeon CJ, Wisniewski AB| title=Congenital adrenal hyperplasia owing to 21-hydroxylase deficiency. Growth, development, and therapeutic considerations. | journal=Endocrinol Metab Clin North Am | year= 2001 | volume= 30 | issue= 1 | pages= 193-206 | pmid=11344936 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11344936  }} </ref>
*Adrenal androgens are readily converted to [[estradiol]], which accelerates [[bone age|bone maturation]] and can lead to early epiphyseal closure.
*Adrenal androgens are readily converted to [[estradiol]], which accelerates [[bone age|bone maturation]] and can lead to early epiphyseal closure.
*Rate of growth is assessed by checking the [[bone age]] every year or two through periodic measurement of [[17OHP]] and [[testosterone]] levels.
*Rate of growth is assessed by checking the [[bone age]] every year or two through periodic measurement of [[17OHP]] and [[testosterone]] levels.
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*[[Aromatase inhibitor]] such as [[testolactone]] also block conversion of testosterone to estradiol.
*[[Aromatase inhibitor]] such as [[testolactone]] also block conversion of testosterone to estradiol.
*[[Bilateral adrenalectomy]] rarely used to remove the androgen sources.
*[[Bilateral adrenalectomy]] rarely used to remove the androgen sources.
*[[Growth hormone treatment]] is used to enhance growth.<ref name="Wikipeadia"> https://en.wikipedia.org/wiki/Congenital_adrenal_hyperplasia_due_to_21-hydroxylase_deficiency</ref><ref name="pmid11344936">{{cite journal| author=Migeon CJ, Wisniewski AB| title=Congenital adrenal hyperplasia owing to 21-hydroxylase deficiency. Growth, development, and therapeutic considerations. | journal=Endocrinol Metab Clin North Am | year= 2001 | volume= 30 | issue= 1 | pages= 193-206 | pmid=11344936 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11344936  }} </ref>
*[[Growth hormone treatment]] is used to enhance growth.


===Childhood onset (simple virilizing) congenital adrenal hyperplasia===
===Childhood onset (simple virilizing) congenital adrenal hyperplasia===

Revision as of 15:26, 5 October 2015

Congenital adrenal hyperplasia due to 21-hydroxylase deficiency Microchapters

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Ahmad Al Maradni, M.D. [2]

Overview

The mainstay of therapy for congenital adrenal hyperplasia due to 21-hydroxylase deficiency is glucocorticoid replacement.

Medical Therapy

The mainstay of therapy for congenital adrenal hyperplasia due to 21-hydroxylase deficiency is glucocorticoid replacement.

Early-onset: Severe 21-hydroxylase deficient congenital adrenal hyperplasia

Salt-wasting crisis in infancy

Long-term management of congenital adrenal hyperplasia

Management of infants and children with congenital adrenal hyperplasia is complex and warrants long term care in a pediatric endocrine clinic. After the diagnosis is confirmed, and any salt-wasting crisis averted or reversed, major management issues include:[2]

  • Initiating and monitoring hormone replacement
  • Stress coverage, crisis prevention, parental education
  • Reconstructive surgery
  • Optimizing growth
  • Optimizing androgen suppression and fertility in women with congenital adrenal hyperplasia
Hormone replacement
  • Glucocorticoids provide a reliable substitute for cortisol and reduce ACTH level. Reducing ACTH also reduces the stimulus for continued hyperplasia and overproduction of androgens in both sexes.[1]
  • Hydrocortisone or liquid prednisolone is preferred in infancy and childhood.
  • Prednisone or dexamethasone are often more convenient for adults.
  • Dose is typically started at the low end of physiologic replacement (6-12 mg/m2) but is adjusted throughout childhood to prevent both growth suppression from too much and androgen escape from too little glucocorticoid.
  • Serum levels of 17OHP, testosterone, androstenedione, and other adrenal steroids are followed for additional information, but may not be entirely normalized even with optimal treatment.

Optimizing growth in congenital adrenal hyperplasia

Childhood onset (simple virilizing) congenital adrenal hyperplasia

The mainstay of treatment is:[1]

Late onset (nonclassical) congenital adrenal hyperplasia

  • Combination of very low dose of glucocorticoid (to reduce adrenal androgen production) and androgen blockers (to induce ovulation) are used in late onset congenital adrenal hyperplasia.

References

  1. 1.0 1.1 1.2 1.3 https://en.wikipedia.org/wiki/Congenital_adrenal_hyperplasia_due_to_21-hydroxylase_deficiency
  2. Schwartz LJ (1977). "Have you told your laboratory man you love him?". Ill Dent J. 46 (6): 281. PMID 275213.
  3. Migeon CJ, Wisniewski AB (2001). "Congenital adrenal hyperplasia owing to 21-hydroxylase deficiency. Growth, development, and therapeutic considerations". Endocrinol Metab Clin North Am. 30 (1): 193–206. PMID 11344936.

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