Prenatal treatment of congenital adrenal hyperplasia-not standard of care.
Congenital adrenal hyperplasia (CAH) due to steroid 21-hydroxylase deficiency is a common autosomal recessive disorder due to mutations in the CYP21A2 gene. Since genetic counselors play a crucial role in educating families about inherited disorders, they need to have thorough knowledge regarding the pathophysiology of CAH especially the effects on the fetus, the complex genetics of this disorder, and the controversies surrounding experimental prenatal dexamethasone treatment. Affected female fetuses may have varying degree of virilization of the external genitalia. Starting in the 1980's, supraphysiologic glucocorticoid treatment was used to decrease the virilization of the external genitalia of affected female fetuses. However, recent clinical observations, animal studies and greater awareness of the details of human fetal adrenal physiology raise concerns regarding the safety of this prenatal treatment. We review the pathophysiology of CAH, the safety and ethical considerations of prenatal dexamethasone treatment and the views of multiple medical societies that conclude that this experimental therapy should only be done in prospective trials approved by ethical review boards.
Department of Pediatrics, Division of Pediatric Endocrinology, Children's Hospital of Pittsburgh of UPMC, University of Pittsburgh, PA 15224, USA. selma.witchel@chp.edu
Selma Feldman
SF
Witchel
Walter L
WL
Miller
D000312:Adrenal Hyperplasia, Congenital / Q000175:diagnosis / Q000201:enzymology / Q000235:genetics / Q000628:therapy*; D000818:Animals; D005260:Female; D005817:Genetic Counseling; D006801:Humans; D008297:Male; D009154:Mutation; D011296:Prenatal Diagnosis; D013255:Steroid 21-Hydroxylase / Q000235:genetics
C531510:CYP21A2 protein, human; D013255:Steroid 21-Hydroxylase