27th May 2025

Management

For classical CAH, the recommended treatment is as follows:

• Glucocorticoid: lifelong glucocorticoids e.g. hydrocortisone prevent further virilisation, and the target dose should maintain physiologic androgen levels.
• Mineralocorticoid: to correct electrolytes and plasma renin activity.
• Sodium chloride: to supplement salt-wasting CAH.
• Growth hormone + gonadotropin releasing hormone analogue: this can be given to infants and children to improve growth rate and final height.
• Genital surgery: this can be offered to remove redundant erectile tissue in virilised females.

For non-classical CAH, the recommended treatment is as follows:

• Glucocorticoid: only recommended for symptomatic non-classical CAH, and when there is risk of premature bone maturation affecting height.
• Growth hormone + gonadotropin releasing hormone analogue: as above.
• Oral contraceptive: can reduce hirsutism.