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Recommendations for treatment of nonclassic congenital adrenal hyperplasia (NCCAH): an update.
Steroids. 2012 Mar 10; 77(4):342-6.S

Abstract

Congenital adrenal hyperplasia (CAH) is a family of autosomal recessive disorders. 21-Hydroxylase deficiency, in which there are mutations in CYP21A2 (the gene encoding the adrenal 21-hydroxylase enzyme), is the most common form (90%) of CAH. In classic CAH there is impaired cortisol production with diagnostic increased levels of 17-OH progesterone. Excess androgen production results in virilization and in the newborn female may cause development of ambiguous external genitalia. Three-fourths of patients with classic CAH also have aldosterone insufficiency, which can result in salt-wasting; in infancy this manifests as shock, hyponatremia and hyperkalemia. CAH has a reported incidence of 1:10,000-1:20,000 births although there is an increased prevalence in certain ethnic groups. Nonclassic CAH (NCCAH) is a less severe form of the disorder, in which there is 20-50% of 21-hydroxylase enzyme activity (vs. 0-5% in classic CAH) and no salt wasting. The degree of symptoms related to androgen excess is variable and may be progressive with age, although some individuals are asymptomatic. NCCAH has an incidence of 1:1000-1:2000 births (0.1-0.2% prevalence) in the White population; an even higher prevalence is noted in certain ethnic groups such as Ashkenazi Jews (1-2%). As many as two-thirds of persons with NCCAH are compound heterozygotes and carry a severe and mild mutation on different alleles. This paper discusses the genetics of NCCAH, along with its variable phenotypic expression, and reviews the clinical course in untreated patients, which includes rapid early childhood growth, advanced skeletal age, premature adrenarche, acne, impaired reproductive function in both sexes and hirsutism as well as menstrual disorders in females. Finally, it addresses treatment with glucocorticoids vs. non treatment and other therapies, particularly with respect to long term issues such as adult metabolic disease including insulin resistance, cardiovascular disease, metabolic syndrome, and bone mineral density.

Authors+Show Affiliations

Division of Pediatric Endocrinology, Children's Hospital of New York-Presbyterian, Columbia University College of Physicians and Surgeons, NY 10032, USA.No affiliation info available

Pub Type(s)

Journal Article
Review

Language

eng

PubMed ID

22186144

Citation

Trapp, Christine M., and Sharon E. Oberfield. "Recommendations for Treatment of Nonclassic Congenital Adrenal Hyperplasia (NCCAH): an Update." Steroids, vol. 77, no. 4, 2012, pp. 342-6.
Trapp CM, Oberfield SE. Recommendations for treatment of nonclassic congenital adrenal hyperplasia (NCCAH): an update. Steroids. 2012;77(4):342-6.
Trapp, C. M., & Oberfield, S. E. (2012). Recommendations for treatment of nonclassic congenital adrenal hyperplasia (NCCAH): an update. Steroids, 77(4), 342-6. https://doi.org/10.1016/j.steroids.2011.12.009
Trapp CM, Oberfield SE. Recommendations for Treatment of Nonclassic Congenital Adrenal Hyperplasia (NCCAH): an Update. Steroids. 2012 Mar 10;77(4):342-6. PubMed PMID: 22186144.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Recommendations for treatment of nonclassic congenital adrenal hyperplasia (NCCAH): an update. AU - Trapp,Christine M, AU - Oberfield,Sharon E, Y1 - 2011/12/13/ PY - 2011/10/13/received PY - 2011/11/22/accepted PY - 2011/12/22/entrez PY - 2011/12/22/pubmed PY - 2012/6/29/medline SP - 342 EP - 6 JF - Steroids JO - Steroids VL - 77 IS - 4 N2 - Congenital adrenal hyperplasia (CAH) is a family of autosomal recessive disorders. 21-Hydroxylase deficiency, in which there are mutations in CYP21A2 (the gene encoding the adrenal 21-hydroxylase enzyme), is the most common form (90%) of CAH. In classic CAH there is impaired cortisol production with diagnostic increased levels of 17-OH progesterone. Excess androgen production results in virilization and in the newborn female may cause development of ambiguous external genitalia. Three-fourths of patients with classic CAH also have aldosterone insufficiency, which can result in salt-wasting; in infancy this manifests as shock, hyponatremia and hyperkalemia. CAH has a reported incidence of 1:10,000-1:20,000 births although there is an increased prevalence in certain ethnic groups. Nonclassic CAH (NCCAH) is a less severe form of the disorder, in which there is 20-50% of 21-hydroxylase enzyme activity (vs. 0-5% in classic CAH) and no salt wasting. The degree of symptoms related to androgen excess is variable and may be progressive with age, although some individuals are asymptomatic. NCCAH has an incidence of 1:1000-1:2000 births (0.1-0.2% prevalence) in the White population; an even higher prevalence is noted in certain ethnic groups such as Ashkenazi Jews (1-2%). As many as two-thirds of persons with NCCAH are compound heterozygotes and carry a severe and mild mutation on different alleles. This paper discusses the genetics of NCCAH, along with its variable phenotypic expression, and reviews the clinical course in untreated patients, which includes rapid early childhood growth, advanced skeletal age, premature adrenarche, acne, impaired reproductive function in both sexes and hirsutism as well as menstrual disorders in females. Finally, it addresses treatment with glucocorticoids vs. non treatment and other therapies, particularly with respect to long term issues such as adult metabolic disease including insulin resistance, cardiovascular disease, metabolic syndrome, and bone mineral density. SN - 1878-5867 UR - https://www.unboundmedicine.com/medline/citation/22186144/Recommendations_for_treatment_of_nonclassic_congenital_adrenal_hyperplasia__NCCAH_:_an_update_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0039-128X(11)00354-0 DB - PRIME DP - Unbound Medicine ER -