title: Congenital adrenal hyperplasia in adults: a review of medical, surgical and psychological issues.
abstract: Our knowledge of the experience of adults with congenital adrenal hyperplasia (CAH) as they pass through life is only now emerging. In this review we gather medical, surgical and psychological literature pertaining to adults with CAH and consider this alongside practical experience gained from a dedicated adult CAH clinic. There is increasing awareness for the need for multidisciplinary teams who have knowledge of CAH particularly with respect to gynaecological surgery and clinical psychology for women and testicular function in men. Routine management of CAH comprises adjustment of glucocorticoid and mineralocorticoid treatment according to individual needs balancing biochemical markers, compliance and long term risks. Bone density is one such long term concern and is not greatly reduced in most individuals with CAH. More recently, attention has turned to cardiovascular risk factors and catecholamine deficiency in adults with CAH. Women with CAH require access to an experienced gynaecologist, specialised pregnancy care and psychosexual support. The very low fertility rates for women with CAH previously reported appear to be improving with time. Men with CAH are often lost to follow up and therefore miss out on surveillance for hypogonadism either through the effect of adrenal rests of from suppression of gonadotrophins resulting in a high prevalence of oligospermia.
authors.affiliation: Department of Endocrinology, Middlesex Hospital, London, UK.
authors.forename: Cara Megan
authors.initials: CM
authors.lastname: Ogilvie
authors.forename: Naomi S
authors.initials: NS
authors.lastname: Crouch
authors.forename: Gill
authors.initials: G
authors.lastname: Rumsby
authors.forename: Sarah M
authors.initials: SM
authors.lastname: Creighton
authors.forename: Lih-Mei
authors.initials: LM
authors.lastname: Liao
authors.forename: Gerard S
authors.initials: GS
authors.lastname: Conway
mesh_terms: D000312:Adrenal Hyperplasia, Congenital / Q000188:drug therapy / Q000473:pathology / Q000523:psychology; D000328:Adult; D005260:Female; D005298:Fertility; D005835:Genitalia / Q000002:abnormalities / Q000601:surgery; D005938:Glucocorticoids / Q000627:therapeutic use; D006801:Humans; D007006:Hypogonadism / Q000188:drug therapy / Q000209:etiology; D008297:Male; D008875:Middle Aged; D008901:Mineralocorticoids / Q000627:therapeutic use; D011247:Pregnancy; D011606:Psychosexual Development; D012737:Sex Factors
chemical_list: D005938:Glucocorticoids; D008901:Mineralocorticoids