Growth and reproductive outcomes in congenital adrenal hyperplasia

Todd D Nebesio, Erica A Eugster, Todd D Nebesio, Erica A Eugster

Abstract

The treatment of congenital adrenal hyperplasia (CAH) due to 21-hydroxylase deficiency is complex. In addition to disease control, important therapeutic goals are the maintenance of normal growth and the acquisition of normal reproductive function. Here, data regarding final adult height (FH) in patients with CAH will be reviewed. Additional difficulties associated with CAH, including risks of obesity and hypertension, will be discussed. Information about fertility and reproductive outcomes in men and women with CAH will also be summarized. Although the treatment of each child with CAH needs to be individualized, close medical followup and laboratory monitoring along with good compliance can often result in positive clinical outcomes.

References

    1. Klingensmith GJ, Garcia SC, Jones HW, Jr., Migeon CJ, Blizzard RM. Glucocorticoid treatment of girls with congenital adrenal hyperplasia: effects on height, sexual maturation, and fertility. The Journal of Pediatrics. 1977;90(6):996–1004.
    1. Ghali I, David M, David L. Linear growth and pubertal development in treated congenital adrenal hyperplasia due to 21 hydroxylase deficiency. Clinical Endocrinology. 1977;6(6):425–436.
    1. Urban MD, Lee PA, Migeon CJ. Adult height and fertility in men with congenital virilizing adrenal hyperplasia. The New England Journal of Medicine. 1978;299(25):1392–1396.
    1. Kirkland RT, Keenan BS, Holcombe JH, Kirkland JL, Clayton GW. The effect of therapy on mature height in congenital adrenal hyperplasia. The Journal of Clinical Endocrinology & Metabolism. 1978;47(6):1320–1324.
    1. Clayton GW. Patterns of growth from birth to maturity in infants and children with congenital adrenal hyperplasia. Acta Endocrinologica. 1986;113(supplement 4):S295–S304.
    1. DiMartino-Nardi J, Stoner E, O’Connell A, New MI. The effect of treatment of final height in classical congenital adrenal hyperplasia (CAH) Acta Endocrinologica. 1986;113(supplement 4):S305–S314.
    1. Young MC, Ribeiro J, Hughes IA. Growth and body proportions in congenital adrenal hyperplasia. Archives of Disease in Childhood. 1989;64(11):1554–1558.
    1. Gargantini L, Calzi P, Brunelli V, Braggion F, Chiumello G. Growth and puberal development in males with adreno-genital syndrome. Pediatria Medica e Chirurgica. 1989;11(6):597–602.
    1. David M, Sempe M, Blanc M, Nicolino M, Forest MG, Morel Y. Final height in 69 patients with congenital adrenal hyperplasia due to 21-hydroxylase deficiency. Archives de Pediatrie. 1994;1(4):363–367.
    1. Kolousková S, Zemková D, Snajderová M, Lebl J. Growth and adult height in patients with congenital adrenal hyperplasia. Casopis Lekaru Ceskych. 1995;134(21):689–691.
    1. Lim YJ, Batch JA, Warne GL. Adrenal 21-hydroxylase deficiency in childhood: 25 years’ experience. Journal of Paediatrics and Child Health. 1995;31(3):222–227.
    1. Yu ACM, Grant DB. Adult height in women with early-treated congenital adrenal hyperplasia (21-hydroxylase type): relation to body mass index in earlier childhood. Acta Paediatrica. 1995;84(8):899–903.
    1. Gussinyé M, Carrascosa A, Potau N, et al. Bone mineral density in prepubertal and in adolescent and young adult patients with the salt-wasting form of congenital adrenal hyperplasia. Pediatrics. 1997;100(4):671–674.
    1. Hauffa BP, Winter A, Stolecke H. Treatment and disease effects on short-term growth and adult height in children and adolescents with 21-hydroxylase deficiency. Klinische Padiatrie. 1997;209(2):71–77.
    1. Jääskeläinen J, Voutilainen R. Growth of patients with 21-hydroxylase deficiency: an analysis of the factors influencing adult height. Pediatric Research. 1997;41(1):30–33.
    1. Premawardhana LDKE, Hughes IA, Read GF, Scanlon MF. Longer term outcome in females with congenital adrenal hyperplasia (CAH): the Cardiff experience. Clinical Endocrinology. 1997;46(3):327–332.
    1. Sellers E, Muirhead S, Guyda H. Adult height outcome in 21-hydroxylase deficiency congenital adrenal hyperplasia. In: Program and Abstracts, The Endocrine Society’s 81st Annual Meeting; 1999; Bethesda, Md, USA. The Endocrine Society Press; p. 308. Poster P2-129.
    1. Eugster EA, DiMeglio LA, Wright JC, Freidenberg GR, Seshadri R, Pescovitz OH. Height outcome in congenital adrenal hyperplasia caused by 21-hydroxylase deficiency: a meta-analysis. The Journal of Pediatrics. 2001;138(1):26–32.
    1. Hargitai G, Sólyom J, Battelino T, et al. Growth patterns and final height in congenital adrenal hyperplasia due to classical 21-hydroxylase deficiency results of a multicenter study. Hormone Research. 2001;55(4):161–171.
    1. Cabrera MS, Vogiatzi MG, New MI. Long term outcome in adult males with classic congenital adrenal hyperplasia. The Journal of Clinical Endocrinology & Metabolism. 2001;86(7):3070–3078.
    1. Manoli I, Kanaka-Gantenbein Ch, Voutetakis A, Maniati-Christidi M, Dacou-Voutetakis C. Early growth, pubertal development, body mass index and final height of patients with congenital adrenal hyperplasia: factors influencing the outcome. Clinical Endocrinology. 2002;57(5):669–676.
    1. Muirhead S, Sellers EAC, Guyda H. Indicators of adult height outcome in classical 21-hydroxylase deficiency congenital adrenal hyperplasia. The Journal of Pediatrics. 2002;141(2):247–252.
    1. Van der Kamp HJ, Otten BJ, Buitenweg N, et al. Longitudinal analysis of growth and puberty in 21-hydroxylase deficiency patients. Archives of Disease in Childhood. 2002;87(2):139–144.
    1. Pinto G, Tardy V, Trivin C, et al. Follow-up of 68 children with congenital adrenal hyperplasia due to 21-hydroxylase deficiency: relevance of genotype for management. The Journal of Clinical Endocrinology & Metabolism. 2003;88(6):2624–2633.
    1. Balsamo A, Cicognani A, Baldazzi L, et al. CYP21 genotype, adult height, and pubertal development in 55 patients treated for 21-hydroxylase deficiency. The Journal of Clinical Endocrinology & Metabolism. 2003;88(12):5680–5688.
    1. Brunelli VL, Russo G, Bertelloni S, et al. Final height in congenital adrenal hyperplasia due to 21-hydroxylase deficiency: the Italian experience. Journal of Pediatric Endocrinology & Metabolism. 2003;16(supplement 2):277–283.
    1. Grigorescu-Sido A, Bettendorf M, Schulze E, Duncea I, Heinrich U. Growth analysis in patients with 21-hydroxylase deficiency influence of glucocorticoid dosage, age at diagnosis, phenotype and genotype on growth and height outcome. Hormone Research. 2003;60(2):84–90.
    1. Tung Y-C, Lee J-S, Tsai W-Y, Hsiao P-H. Adult height of patients with classical congenital adrenal hyperplasia. Journal of the Formosan Medical Association. 2005;104(2):133–136.
    1. Lemos-Marini SH, Guerra-Júnior G, Morcillo AM, Baptista MT, Silva LO, Maciel-Guerra AT. Congenital adrenal hyperplasia due to 21-hydroxylase deficiency: final height in 27 patients with the classical form. Arquivos Brasileiros de Endocrinologia e Metabologia. 2005;49(6):902–907.
    1. Aycan Z, Ocal G, Berberoglu M, Cetinkaya E, Adiyaman P, Evliyaoglu O. Experience with long-term glucocorticoid treatment in congenital adrenal hyperplasia: growth pattern compared with genetic height potential. Journal of Pediatric Endocrinology & Metabolism. 2006;19(3):245–251.
    1. Sciannamblo M, Russo G, Cuccato D, Chiumello G, Mora S. Reduced bone mineral density and increased bone metabolism rate in young adult patients with 21-hydroxylase deficiency. The Journal of Clinical Endocrinology & Metabolism. 2006;91(11):4453–4458.
    1. Bonfig W, Bechtold S, Schmidt H, Knorr D, Schwarz HP. Reduced final height outcome in congenital adrenal hyperplasia under prednisone treatment: deceleration of growth velocity during puberty. The Journal of Clinical Endocrinology & Metabolism. 2007;92(5):1635–1639.
    1. Chakhtoura Z, Bachelot A, Samara-Boustani D, et al. Impact of total cumulative glucocorticoid dose on bone mineral density in patients with 21-hydroxylase deficiency. European Journal of Endocrinology. 2008;158(6):879–887.
    1. Hoepffner W, Kaufhold A, Willgerodt H, Keller E. Patients with classic congenital adrenal hyperplasia due to 21-hydroxylase deficiency can achieve their target height: the Leipzig experience. Hormone Research. 2008;70(1):42–50.
    1. Dörr HG. Growth in patients with classic congenital adrenal hyperplasia due to 21-hydroxylase deficiency. Hormone Research. 2007;68(supplement 5):93–99.
    1. Hochberg Z. Mechanisms of steroid impairment of growth. Hormone Research. 2002;58(supplement 1):33–38.
    1. Borges M-HS, Pinto ACAR, DiNinno FB, et al. IGF-I levels rise and GH responses to GHRH decrease during long-term prednisone treatment in man. Journal of Endocrinological Investigation. 1999;22(1):12–17.
    1. Skjærbæk C, Frystyk J, Grøfte T, et al. Serum free insulin-like growth factor-I is dose-dependently decreased by methylprednisolone and related to body weight changes in rats. Growth Hormone & IGF Research. 1999;9(1):74–80.
    1. Beauloye V, Ketelslegers JM, Moreau B, Thissen JP. Dexamethasone inhibits both growth hormone (GH)-induction of insulin-like growth factor-I (IGF-I) mRNA and GH receptor (GHR) mrna levels in rat primary cultured hepatocytes. Growth Hormone & IGF Research. 1999;9(3):205–211.
    1. Chrysis D, Zaman F, Chagin AS, Takigawa M, Sävendahl L. Dexamethasone induces apoptosis in proliferative chondrocytes through activation of caspases and suppression of the Akt-phosphatidylinositol 3′-kinase signaling pathway. Endocrinology. 2005;146(3):1391–1397.
    1. Silva IN, Kater CE, Cunha CDF, Viana MB. Randomised controlled trial of growth effect of hydrocortisone in congenital adrenal hyperplasia. Archives of Disease in Childhood. 1997;77(3):214–218.
    1. Balsamo A, Wasniewska M, Di Pasquale G, et al. Birth length and weight in congenital adrenal hyperplasia according to the different phenotypes. European Journal of Pediatrics. 2006;165(6):380–383.
    1. Claahsen-van der Grinten HL, Noordam K, Borm GF, Otten BJ. Absence of increased height velocity in the first year of life in untreated children with simple virilizing congenital adrenal hyperplasia. The Journal of Clinical Endocrinology & Metabolism. 2006;91(4):1205–1209.
    1. Einaudi S, Lala R, Corrias A, Matarazzo P, Pagliardini S, de Sanctis C. Auxological and biochemical parameters in assessing treatment of infants and toddlers with congenital adrenal hyperplasia due to 21-hydroxylase deficiency. The Journal of Pediatric Endocrinology. 1993;6(2):173–178.
    1. Stikkelbroeck NMML, Van’t Hof-Grootenboer BAE, Hermus ARMM, Otten BJ, Van’t Hof MA. Growth inhibition by glucocorticoid treatment in salt wasting 21-hydroxylase deficiency: in early infancy and (pre)puberty. The Journal of Clinical Endocrinology & Metabolism. 2003;88(8):3525–3530.
    1. Thilen A, Woods KA, Perry LA, Savage MO, Wedell A, Ritzen EM. Early growth is not increased in untreated moderately severe 21-hydroxylase deficiency. Acta Paediatrica. 1995;84(8):894–898.
    1. Frisch H, Waldhauser F, Lebl J, et al. Congenital adrenal hyperplasia: lessons from a multinational study. Hormone Research. 2002;57(supplement 2):95–101.
    1. Bonfig W, Pozza SBD, Schmidt H, Pagel P, Knorr D, Schwarz HP. Hydrocortisone dosing during puberty in patients with classical congenital adrenal hyperplasia: an evidence-based recommendation. The Journal of Clinical Endocrinology & Metabolism. 2009;94(10):3882–3888.
    1. Lima L, Arce V, Diaz MJ, Tresguerres JAF, Devesa J. Glucocorticoids may inhibit growth hormone release by enhancing β-adrenergic responsiveness in hypothalamic somatostatin neurons. The Journal of Clinical Endocrinology & Metabolism. 1993;76(2):439–444.
    1. Devesa J, Barros MG, Gondar M, Tresguerres JAF, Arce V. Regulation of hypothalamic somatostatin by glucocorticoids. Journal of Steroid Biochemistry and Molecular Biology. 1995;53(1–6):277–282.
    1. Quintos JBQ, Vogiatzi MG, Harbison MD, New MI. Growth hormone therapy alone or in combination with gonadotropin-releasing hormone analog therapy to improve the height deficit in children with congenital adrenal hyperplasia. The Journal of Clinical Endocrinology & Metabolism. 2001;86(4):1511–1517.
    1. New MI. Factors determining final height in congenital adrenal hyperplasia. Journal of Pediatric Endocrinology & Metabolism. 2001;14(supplement 2):933–937.
    1. Lin-Su K, Vogiatzi MG, Marshall I, et al. Treatment with growth hormone and luteinizing hormone releasing hormone analog improves final adult height in children with congenital adrenal hyperplasia. The Journal of Clinical Endocrinology & Metabolism. 2005;90(6):3318–3325.
    1. Laue L, Merke DP, Jones JV, Barnes KM, Hill S, Cutler GB., Jr. A preliminary study of flutamide, testolactone, and reduced hydrocortisone dose in the treatment of congenital adrenal hyperplasia. The Journal of Clinical Endocrinology & Metabolism. 1996;81(10):3535–3539.
    1. Merke DP, Keil MF, Jones JV, Fields J, Hill S, Cutler GB., Jr. Flutamide, testolactone, and reduced hydrocortisone dose maintain normal growth velocity and bone maturation despite elevated androgen levels in children with congenital adrenal hyperplasia. The Journal of Clinical Endocrinology & Metabolism. 2000;85(3):1114–1120.
    1. Kuhnle U, Rosler A, Pareira JA, Gunzcler P, Levine LS, New MI. The effects of long-term normalization of sodium balance on linear growth in disorders with aldosterone deficiency. Acta Endocrinologica. 1983;102(4):577–582.
    1. Nimkarn S, Lin-Su K, Berglind N, Wilson RC, New MI. Aldosterone-to-renin ratio as a marker for disease severity in 21-hydroxylase deficiency congenital adrenal hyperplasia. The Journal of Clinical Endocrinology & Metabolism. 2007;92(1):137–142.
    1. Cornean RE, Hindmarsh PC, Brook CGD. Obesity in 21-hydroxylase deficient patients. Archives of Disease in Childhood. 1998;78(3):261–263.
    1. Völkl TMK, Simm D, Beier C, Dörr HG. Obesity among children and adolescents with classic congenital adrenal hyperplasia due to 21-hydroxylase deficiency. Pediatrics. 2006;117(1):e98–e105.
    1. Nebesio TD. Hypertension in children with 21-hydroxylase deficiency. Congenital Adrenal Hyperplasia Research Education & Support (CARES) Foundation Newsletter. 2007;6(3):14–15.
    1. Vazquez AM, Kenny FM. Hypertension secondary to excessive desoxycorticosterone implants or 9-alpha fluorocortisol in salt-losing congenital adrenal hyperplasia. The Journal of Pediatrics. 1972;81(3):549–552.
    1. Kirkland JL, Kirkland RT, Librik L, Clayton GW. Iatrogenic hypertension in children with congenital adrenal hyperplasia. The Journal of Pediatrics. 1973;83(4):687–689.
    1. Roche EF, Charmandari E, Dattani MT, Hindmarsh PC. Blood pressure in children and adolescents with congenital adrenal hyperplasia (21-hydroxylase deficiency): a preliminary report. Clinical Endocrinology. 2003;58(5):589–596.
    1. de Silva KSH, Kanumakala S, Brown JJ, Jones CL, Warne GL. 24-hour ambulatory blood presurre profile in patients with congenital adrenal hyperplasia—a preliminary report. Journal of Pediatric Endocrinology & Metabolism. 2004;17(8):1089–1095.
    1. Völkl TMK, Simm D, Dötsch J, Rascher W, Dörr HG. Altered 24-hour blood pressure profiles in children and adolescents with classical congenital adrenal hyperplasia due to 21-hydroxylase deficiency. The Journal of Clinical Endocrinology & Metabolism. 2006;91(12):4888–4895.
    1. Hoepffner W, Herrmann A, Willgerodt H, Keller E. Blood pressure in patients with congenital adrenal hyperplasia due to 21-hydroxylase deficiency. Journal of Pediatric Endocrinology & Metabolism. 2006;19(5):705–711.
    1. Nebesio TD, Eugster EA. Observation of hypertension in children with 21-hydroxylase deficiency: a preliminary report. Endocrine. 2006;30(3):279–282.
    1. Claahsen-van der Grinten HL, Stikkelbroeck NMML, Sweep CGJ, Hermus ARMM, Otten BJ. Fertility in patients with congenital adrenal hyperplasia. Journal of Pediatric Endocrinology & Metabolism. 2006;19(5):677–685.
    1. Claahsen-van der Grinten HL, Otten BJ, Stikkelbroeck MML, Sweep FCGJ, Hermus ARMM. Testicular adrenal rest tumours in congenital adrenal hyperplasia. Best Practice & Research: Clinical Endocrinology & Metabolism. 2009;23(2):209–220.
    1. Stikkelbroeck NMML, Otten BJ, Pasic A, et al. High prevalence of testicular adrenal rest tumors, impaired spermatogenesis, and Leydig cell failure in adolescent and adult males with congenital adrenal hyperplasia. The Journal of Clinical Endocrinology & Metabolism. 2001;86(12):5721–5728.
    1. Reisch N, Flade L, Scherr M, et al. High prevalence of reduced fecundity in men with congenital adrenal hyperplasia. The Journal of Clinical Endocrinology & Metabolism. 2009;94(5):1665–1670.
    1. Claahsen-van der Grinten HL, Otten BJ, Hermus ARMM, Sweep FCGJ, Hulsbergen-van de Kaa CA. Testicular adrenal rest tumors in patients with congenital adrenal hyperplasia can cause severe testicular damage. Fertility and Sterility. 2008;89(3):597–601.
    1. Claahsen-van der Grinten HL, Otten BJ, Sweep FCGJ, et al. Testicular tumors in patients with congenital adrenal hyperplasia due to 21-hydroxylase deficiency show functional features of adrenocortical tissue. The Journal of Clinical Endocrinology & Metabolism. 2007;92(9):3674–3680.
    1. Claahsen-van der Grinten HL, Otten BJ, Sweep FCGJ, Hermus ARMM. Repeated successful induction of fertility after replacing hydrocortisone with dexamethasone in a patient with congenital adrenal hyperplasia and testicular adrenal rest tumors. Fertility and Sterility. 2007;88(3):705.e5–705.e8.
    1. Mouritsen A, Juul A, Jørgensen N. Improvement of semen quality in an infertile man with 21-hydroxylase deficiency, suppressed serum gonadotropins and testicular adrenal rest tumours. International Journal of Andrology. 2009:1–4.
    1. Claahsen-van der Grinten HL, Otten BJ, Takahashi S, et al. Testicular adrenal rest tumors in adult males with congenital adrenal hyperplasia: evaluation of pituitary-gonadal function before and after successful testis-sparing surgery in eight patients. The Journal of Clinical Endocrinology & Metabolism. 2007;92(2):612–615.
    1. Claahsen-van der Grinten HL, Sweep FCGJ, Blickman JG, Hermus ARMM, Otten BJ. Prevalence of testicular adrenal rest tumors in male children with congenital adrenal hyperplasia due to 21-hydroxylase deficiency. European Journal of Endocrinology. 2007;157(3):339–344.
    1. Martinez-Aguayo A, Rocha A, Rojas N, et al. Testicular adrenal rest tumors and Leydig and Sertoli cell function in boys with classical congenital adrenal hyperplasia. The Journal of Clinical Endocrinology & Metabolism. 2007;92(12):4583–4589.
    1. Claahsen-van der Grinten HL, Hermus ARMM, Otten BJ. Testicular adrenal rest tumours in congenital adrenal hyperplasia. International Journal of Pediatric Endocrinology. 2009;2009:8 pages. Article ID 624823.
    1. Mulaikal RM, Migeon CJ, Rock JA. Fertility rates in female patients with congenital adrenal hyperplasia due to 21-hydroxylase deficiency. The New England Journal of Medicine. 1987;316(4):178–182.
    1. Jääskeläinen J, Hippeläinen M, Kiekara O, Voutilainen R. Child rate, pregnancy outcome and ovarian function in females with classical 21-hydroxylase deficiency. Acta Obstetricia et Gynecologica Scandinavica. 2000;79(8):687–692.
    1. Lo JC, Grumbach MM. Pregnancy outcomes in women with congenital virilizing adrenal hyperplasia. Endocrinology and Metabolism Clinics of North America. 2001;30(1):207–229.
    1. Krone N, Wachter I, Stefanidou M, Roscher AA, Schwarz HP. Mothers with congenital adrenal hyperplasia and their children: outcome of pregnancy, birth and childhood. Clinical Endocrinology. 2001;55(4):523–529.
    1. Stikkelbroeck NMML, Hermus ARMM, Braat DDM, Otten BJ. Fertility in women with congenital adrenal hyperplasia due to 21-hydroxylase deficiency. Obstetrical & Gynecological Survey. 2003;58(4):275–284.
    1. Gastaud F, Bouvattier C, Duranteau L, et al. Impaired sexual and reproductive outcomes in women with classical forms of congenital adrenal hyperplasia. The Journal of Clinical Endocrinology & Metabolism. 2007;92(4):1391–1396.
    1. Hagenfeldt K, Janson PO, Holmdahl G, et al. Fertility and pregnancy outcome in women with congenital adrenal hyperplasia due to 21-hydroxylase deficiency. Human Reproduction. 2008;23(7):1607–1613.
    1. Conway GS, Casteràs A, De Silva P, Rumsby G. Reassessing fecundity in women with classical congenital adrenal hyperplasia (CAH): normal pregnancy rate but reduced fertility rate. Clinical Endocrinology. 2009;70(6):833–837.
    1. Meyer-Bahlburg HFL. What causes low rates of child-bearing in congenital adrenal hyperplasia? The Journal of Clinical Endocrinology & Metabolism. 1999;84(6):1844–1847.
    1. Hoepffner W, Schulze E, Bennek J, Keller E, Willgerodt H. Pregnancies in patients with congenital adrenal hyperplasia with complete or almost complete impairment of 21-hydroxylase activity. Fertility and Sterility. 2004;81(5):1314–1321.
    1. Kulshreshtha B, Marumudi E, Khurana ML, et al. Fertility among women with classical congenital adrenal hyperplasia: report of seven cases where treatment was started after 9 years of age. Gynecological Endocrinology. 2008;24(5):267–272.
    1. Dumic M, Janjanin N, Ille J, et al. Pregnancy outcomes in women with classical congenital adrenal hyperplasia due to 21-hydroxylase deficiency. Journal of Pediatric Endocrinology & Metabolism. 2005;18(9):887–895.
    1. Russo G, Paesano P, Taccagni G, Del Maschio A, Chiumello G. Ovarian adrenal-like tissue in congenital adrenal hyperplasia. The New England Journal of Medicine. 1998;339(12):853–854.
    1. Al-Ahmadie HA, Stanek J, Liu J, Mangu PN, Niemann T, Young RH. Ovarian ‘tumor’ of the adrenogenital syndrome: the first reported case. American Journal of Surgical Pathology. 2001;25(11):1443–1450.
    1. Claahsen-van der Grinten HL, Hulsbergen-van de Kaa CA, Otten BJ. Ovarian adrenal rest tissue in congenital adrenal hyperplasia—a patient report. Journal of Pediatric Endocrinology & Metabolism. 2006;19(2):177–182.
    1. Stikkelbroeck NMML, Hermus ARMM, Schouten D, et al. Prevalence of ovarian adrenal rest tumours and polycystic ovaries in females with congenital adrenal hyperplasia: results of ultrasonography and MR imaging. European Radiology. 2004;14(10):1802–1806.
    1. Lo JC, Schwitzgebel VM, Tyrrell JB, et al. Normal female infants born of mothers with classic congenital adrenal hyperplasia due to 21-hydroxylase deficiency. The Journal of Clinical Endocrinology & Metabolism. 1999;84(3):930–936.
    1. Kai H, Nose O, Iida Y, Ono J, Harada T, Yabuuchi H. Female pseudohermaphroditism caused by maternal congenital adrenal hyperplasia. The Journal of Pediatrics. 1979;95(3):418–420.
    1. Zacharin M. Fertility and its complications in a patient with salt losing congenital adrenal hyperplasia. Journal of Pediatric Endocrinology & Metabolism. 1999;12(1):89–94.
    1. Nebesio TD, Kreher NC, Hannon TS. Infant with classic congenital adrenal hyperplasia (CAH) born to a mother with classic CAH. The Journal of Pediatrics. 2004;145(2):250–252.

Source: PubMed

Sponsors en medewerkers

Medische omstandigheden

Geneesmiddelinterventies

3
Abonneren