Novel basic and clinical aspects of congenital adrenal hyperplasia

Postnatal testosterone levels and disorder relevant behavior in the second year of life

The objective of the current study was to investigate the relationship between testosterone collected at 3-4 months of age and sex-linked disorder-relevant behaviors in the second year of life. Eighty-four children participated at 3-4 (when salivary testosterone levels were obtained and second to fourth digit ratios were measured) and 18-24 months of age (when behavioral ratings of aggression and verbal ability were coded from two 8-min play sessions). Parents also completed the Brief Infant-Toddler Social and Emotional Assessment, and the four subscales (Internalizing, Externalizing, Dysregulation, and Autism Spectrum Disorder) were used to indicate child specific problems. Greater postnatal testosterone levels in early infancy were predictive of more male-typical behaviors in the second year of life (i.e., more autism spectrum behaviors, less time vocalizing, and more Internalizing Problems). These results support the hypothesis that early infancy may be another critical period for the development of gender-linked behavior.

Outcome of bilateral adrenalectomy in congenital adrenal hyperplasia: one unit's experience

OBJECTIVE

The use of bilateral adrenalectomy in the management of congenital adrenal hyperplasia (CAH) is controversial. We set out to review the outcome of 5 cases of CAH who have undergone adrenalectomy in our unit.

DESIGN

A retrospective case note review and subject interview of the experience of adrenalectomy in the setting of a tertiary adult CAH clinic.

METHODS

Subjects who had undergone adrenalectomy were reviewed at a routine clinic visit with particular reference to clinical and biochemical outcomes after adrenalectomy.

RESULTS

Two subjects underwent surgery for the sole indication of desire for fertility with successful outcome and without subsequent adrenal crises. Three women suffered from the common clinical management problem of unsuppressible hyperandrogenism and worsening obesity. Whilst the outcome of improved appearance and weight loss was achieved in these subjects, all three experienced significant complications including pigmentation and acute episodes of adrenal insufficiency.

CONCLUSION

We present a mean follow-up of 4.2 patient years and conclude that this procedure may be suitable for selected women with CAH. Outcomes for those pursuing fertility were positive; however, complications were noted in those women for whom the procedure was performed for symptom control. Accepting that the number of subjects is small, it is clear that more data are required before widely recommending this procedure.

Congenital adrenal hyperplasia in adults: a review of medical, surgical and psychological issues

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.