9
➤ In patients with congenital adrenal hyperplasia under everyday mental
and emotional stress and minor illness and/or before routine physical
exercise, ES recommends against the use of increased glucocorticoid
doses. (1|⊕⊕
)
➤ In patients with congenital adrenal hyperplasia who require treatment,
ES recommends always wearing or carrying medical identification
indicating that they have adrenal insufficiency. (1|⊕⊕⊕
)
➤ In patients with congenital adrenal hyperplasia, ES recommends
educating patients and their guardians and close contacts on adrenal
crisis prevention and increasing the dose of glucocorticoid (but not
mineralocorticoid) during intercurrent illness. (1|⊕⊕⊕
)
➤ ES recommends equipping every patient with congenital adrenal
hyperplasia with a glucocorticoid injection kit for emergency use and
providing education on parenteral self-administration (young adult
and older) or lay administration (parent or guardian) of emergency
glucocorticoids. (1|⊕⊕⊕
)
Monitoring Therapy
➤ In patients ≤18 months with congenital adrenal hyperplasia, ES
recommends close monitoring in the first 3 months of life and every
3 months thereafter. After 18 months, ES recommends evaluation every
4 months. (1|⊕⊕
)
➤ In pediatric patients with congenital adrenal hyperplasia, ES recommends
conducting regular assessments of growth velocity, weight, blood
pressure, as well as physical examinations in addition to obtaining
biochemical measurements to assess the adequacy of glucocorticoid and
mineralocorticoid. (1|⊕⊕
)
➤ In pediatric patients with congenital adrenal hyperplasia over the age of
2 years, ES advises annual bone age assessment until near-adult height is
attained. (UGPS)
➤ In adults with congenital adrenal hyperplasia, ES recommends annual
physical examinations, which include assessments of blood pressure,
body mass index, and Cushingoid features in addition to obtaining
biochemical measurements to assess the adequacy of glucocorticoid and
mineralocorticoid replacement. (1|⊕⊕
)
➤ In adults with congenital adrenal hyperplasia, ES recommends monitoring
treatment through consistently timed hormone measurements relative to
medication schedule and time of day. (1|⊕⊕
)
➤ In adults with congenital adrenal hyperplasia, ES recommends that
clinicians do not completely suppress endogenous adrenal steroid
secretion to prevent adverse effects of over treatment. (1|⊕⊕⊕
)
