Figure 3. Fertility and Pregnancy
Adolescent women
with CAH
Pregnancy
GYN exam under
anesthesia
Continue GC & MC
Adjust as needed
Avoid
dexamethasone
and other GCs that
cross the placenta
Birth of CAH child
Genetic counseling
Table 1. Maintenance Therapy in Growing CAH Patients
Drugs
Total Dose
Daily Distribution
GCs: HC tablets
10-15 mg/m per day
3 times per day
MCs: fludrocortisone tablets
0.05-0.2 mg per day
1-2 times per day
1-2 g/day (17-34 mEq/day)
in infancy
Divided in several feedings
Sodium chloride
supplements
2
The doses and schedules are meant as examples and should not be construed as a restrictive menu of
choices for the individual patient.
Table 2. Maintenance Therapy Suggested in Fully
Grown Patients
Type of Long-acting GC
Suggested Dose (mg/day)
Daily Doses
HC
15-25
2-3
Prednisone
5-7.5
2
4-6
2
Dexamethasone
0.25-0.5
1
Fludrocortisone
0.05-0.2
1
Prednisolonea
a
a
Suspension or elixir may permit better dose titration for these drugs.
Table 3. Suggested Stress Doses of GC
Patient Age
Infants and preschool children
Initial Parenteral HC Dose (mg)
25
School-age children
50
Adults
100
Successive IV HC doses are given as three to four times maintenance doses per day, divided every 6 h.
Stress dosing should be rapidly tapered to maintenance dosing when patient is clinically stable.
