17 alpha-hydroxylase deficiency medical therapy
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Congenital adrenal hyperplasia due to 17 alpha-hydroxylase deficiency Microchapters |
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Ammu Susheela, M.D. [2]
Overview
The mainstay of therapy for congenital adrenal hyperplasia due to 17 alpha-hydroxylase is glucocorticoid therapy.
Medical Therapy
- Hypertension and mineralocorticoid excess is treated with glucocorticoid replacement, as in other forms of CAH.
- Hydrocortisone is the drug of choice
- Most genetic females with both forms of the deficiency will need replacement estrogen to induce puberty. Most will also need periodic progestin to regularize menses. Fertility is usually reduced because egg maturation and ovulation is poorly supported by the reduced intra-ovarian steroid production.
- The most difficult management decisions are posed by the more ambiguous genetic (XY) males. Most who are severely undervirilized, looking more female than male, are raised as females with surgical removal of the nonfunctional testes. If raised as males, a brief course of testosterone can be given in infancy to induce growth of the penis. Surgery may be able to repair the hypospadias. The testes should be salvaged by orchiopexy if possible. Testosterone must be replaced in order for puberty to occur and continued throughout adult life.