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Cited by 159Sexual Differentiation and DisordersAdrenal Hormones and DisordersOvarian function and disorders

MANAGEMENT OF ENDOCRINE DISEASE: diagnosis and management of the patient with non-classic CAH due to 21-hydroxylase deficiency

Nordenström, Anna, Falhammar, Henrik·2019·European Journal of Endocrinology
DOI 10.1530/eje-18-0712
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Abstract

Non-classic congenital adrenal hyperplasia (NCAH) is a relatively common disorder regardless of ethnicity, but most cases are never diagnosed, especially in males. A baseline 17-hydroxyprogesterone measurement may be used for screening, but 17-hydroxyprogesterone measurement after ACTH stimulation is the gold standard. We advocate a CYP21A2 mutation analysis to verify the diagnosis, for genetic counselling and for better prognostic and treatment guidance. Most patients are diagnosed in adolescence and adult life with hirsutism, acne, a PCOS-like picture and fertility issues. Many men with NCAH never seek medical attention and escape diagnosis. Although treatment is somewhat controversial, an early diagnosis and start of treatment may have positive implications on growth and be relevant for preventing and ameliorating the symptoms and consequences of androgen excess that develop over time, including fertility issues. Long-term treatment with glucocorticoids will improve the androgen symptoms but may result in long-term complications, such as obesity, insulin resistance, hypertension, osteoporosis and fractures. The glucocorticoid doses should be kept low. However, complications seen in NCAH, assumed to be caused by the glucocorticoid treatment, may also be associated with long-term androgen exposure. Oral contraceptive pills are a common treatment option for young females with NCAH. Regular clinical monitoring to improve the clinical outcome is recommended. It is important to acknowledge that glucocorticoid treatment will lead to secondary cortisol insufficiency and the need for stress dosing. Studies focusing on the specific difficulties patients with NCAH face, both those with a late clinical diagnosis and those with a neonatal diagnosis obtained by screening, are warranted.

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Crossref · 10.1530/eje-18-0712

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165 of 165 references verified0 citation errors · 0 not checkable

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  • Children with NC CAH can present with signs of increased adrenal androgen production such as premature pubarche, acne, mild hirsutism and menstrual disturbances that can progress over time.

    “Children with NC CAH can present with signs of increased adrenal androgen production such as premature pubarche, acne, mild hirsutism and menstrual disturbances that can progress over time (427),”

    From Congenital Adrenal Hyperplasia—Current Insights in Pathophysiology, Diagnostics, and Management (2022) · cites this paper as [427]

  • Typical symptoms in affected women with NC CAH are hirsutism, oligo- and amenorrhea, acne, alopecia and sub-or infertility.

    “Typical symptoms in affected women are hirsutism, oligo-and amenorrhea, acne, alopecia and sub-or infertility (427).”

    From Congenital Adrenal Hyperplasia—Current Insights in Pathophysiology, Diagnostics, and Management (2022) · cites this paper as [427]

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Authors
Nordenström, A., & Falhammar, H.
Affiliations
Karolinska University Hospital (SE)
Corresponding author
Nordenström, Anna
ORCID
Venue
European Journal of Endocrinology
Publisher
Oxford University Press (OUP)
Published
2019-03
Volume
180
Issue
3
Pages
R127-R145
ISSN
  • 0804-4643 (ISSN-L)
  • 1479-683X
DOI
10.1530/eje-18-0712
OpenAlex
W2904713638
Cited by
158
References
166
Citations by year
2026: 13 · 2025: 12 · 2024: 22 · 2023: 30 · 2022: 27 · 2021: 25 · 2020: 20 · 2019: 9
FWCI
4.80
Type
journal article
Language
en
Open access
closed
Locations
  • European Journal of Endocrinology (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Life Sciences › Biochemistry, Genetics and Molecular Biology › Molecular Biology › Sexual Differentiation and Disorders
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Adrenal Hormones and Disorders
  • Health Sciences › Medicine › Reproductive Medicine › Ovarian function and disorders
Keywords
non-classical congenital adrenal hyperplasia, 21-hydroxylase deficiency, 17-hydroxyprogesterone, ACTH stimulation test, hirsutism, hyperandrogenism, glucocorticoid therapy, glucocorticoid adverse effects, oral contraceptives, fertility, genetic counseling, screening

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