New ideas for medical treatment of congenital adrenal hyperplasia.
During the past 50 years since the discovery of cortisone therapy as an effective treatment for CAH, many advances have been made in the management of 21-hydroxylase deficiency. Despite these advances, the clinical management of patients with CAH is often complicated by abnormal growth and development, iatrogenic Cushing's syndrome, inadequately treated hyperandrogenism, and infertility. New treatment approaches to classic CAH represent potential solutions to these unresolved issues. At the National Institutes of Health, a long-term randomized clinical trial is investigating a new treatment regimen: a reduced hydrocortisone dose, an antiandrogen, and an aromatase inhibitor. Peripheral blockade of androgens may also be helpful in the adult woman with CAH and PCOS. Other promising new treatment approaches include LHRH agonist-induced pubertal delay with or without growth hormone therapy, alternative glucocorticoid preparations or dose schedules, CRH antagonist treatment, and gene therapy. The applicability and success of these new approaches await the results of current research.
Merke
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DP
Warren Grant Magnuson Clinical Center and the Pediatric and Reproductive Endocrinology Branch, National Institute of Child Health and Human Development of the National Institutes of Health, Bethesda, Maryland, USA. dmerke@nih.gov
Cutler
G B
GB
D000311:Adrenal Glands / Q000187:drug effects / Q000378:metabolism; D000312:Adrenal Hyperplasia, Congenital / Q000188:drug therapy / Q000628:therapy*; D000726:Androgen Antagonists / Q000627:therapeutic use; D000728:Androgens / Q000096:biosynthesis; D003346:Corticotropin-Releasing Hormone / Q000037:antagonists & inhibitors; D004965:Estrogen Antagonists / Q000627:therapeutic use; D015316:Genetic Therapy; D005938:Glucocorticoids / Q000008:administration & dosage; D007987:Gonadotropin-Releasing Hormone / Q000819:agonists; D019382:Human Growth Hormone / Q000627:therapeutic use; D006801:Humans
D000726:Androgen Antagonists; D000728:Androgens; D004965:Estrogen Antagonists; D005938:Glucocorticoids; D019382:Human Growth Hormone; D007987:Gonadotropin-Releasing Hormone; D003346:Corticotropin-Releasing Hormone