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➤ In severely virilized females, ES advises discussion about early surgery to
repair the urogenital sinus. (UGPS)
➤ In the treatment of minors with congenital adrenal hyperplasia, ES advises
that all surgical decisions remain the prerogative of families (i.e., parents
and assent from older children) in joint decision making with experienced
surgical consultants. (UGPS)
➤ In female patients with congenital adrenal hyperplasia for whom surgery
is chosen, ES suggests vaginoplasty using urogenital mobilization and,
when chosen, neurovascular-sparing clitoroplasty for severe clitoromegaly.
(2|⊕
)
Experimental Therapies and Future Directions
General Considerations and Unmet Clinical Needs
➤ In patients with congenital adrenal hyperplasia, ES advises against using
experimental treatment approaches outside of formally approved clinical
trials. (UGPS)
Adrenalectomy
➤ In patients with congenital adrenal hyperplasia, ES suggests that bilateral
adrenalectomy not be performed. (2|⊕
)
Mental Health
➤ For individuals with congenital adrenal hyperplasia and their parents,
ES recommends behavioral/mental health consultation and evaluation to
address any concerns related to congenital adrenal hyperplasia. (1|⊕⊕
)
• Technical remark: Clinicians should be aware that individuals with congenital
adrenal hyperplasia may be at risk for developing mental health problems and should
have a low threshold for referral to psychological or psychiatric treatment. Mental
health practitioners should have specialized expertise in assessing and managing
congenital adrenal hyperplasia–related psychosocial problems.
