When you’ve got basic CAH or nonclassic CAH with signs, medicines can be found to assist repair your physique’s imbalance of hormone ranges — specifically, an absence of cortisol and aldosterone and extra androgen. Individuals who have nonclassic CAH with out signs gained’t want remedy.
Mineralocorticoids
Fludrocortisone (Florinef Acetate) is a steroid medicine that replaces the hormone aldosterone. This helps increase growth and progress, counter sodium loss, and stop adrenal crises (a life-threatening emergency that happens when cortisol and aldosterone ranges are too low).
Glucocorticoids
Glucocorticoids (aka corticosteroids or just steroids) substitute the hormone cortisol. This helps handle adrenal insufficiency, management androgen ranges, and help in growth and progress. Choices embody:
- dexamethasone
- hydrocortisone
- methylprednisolone
- prednisolone
- prednisone
- Elevated urge for food and weight acquire
- Temper adjustments
- Extra physique hair
- Muscle weak spot
- Threat of an infection
- Indicators of excessive blood sugar (i.e., feeling hungry or thirsty or urinating extra incessantly than regular)
- Pores and skin adjustments (together with zits)
- Abdomen irritation
In kids, glucocorticoids may additionally trigger progress delays, says Phyllis Speiser, MD, a pediatric endocrinologist at Cohen Youngsters’s Medical Middle of New York and an affiliate investigator on the Feinstein Institutes for Medical Analysis at Northwell Well being in Manhasset, New York.
Due to these unwanted effects, “We normally advocate the least long-acting or least potent glucocorticoid, which is hydrocortisone, for every day upkeep,” says Dr. Speiser. “For youngsters, we’re particularly vigilant about sustaining the bottom potential dose to attain efficient adrenal management.”
The opposite medicine are used “for conditions by which a affected person doesn’t reply as anticipated to the hydrocortisone routine,” she says.
Corticotropin-Releasing Issue Sort 1 Receptor Antagonists
A medicine known as crinecerfont (Crenessity) is a corticotropin-releasing issue sort 1 receptor antagonist that may also be used with glucocorticoids to raised management androgen ranges in adults and youngsters over age 4 who’ve basic CAH. This enables for a decreased every day glucocorticoid dose whereas sustaining management of androgen ranges.
Salt Dietary supplements
Medicine Concerns
Individuals who take medicine for CAH can be monitored repeatedly, says Speiser. For instance, follow-up visits could also be:
- Each 1 to 2 months for infants
- Each 4 to six months for youngsters
- Each 6 to 12 months for adults
In folks with CAH, these with the basic sort might want to take medicine for all times, says Speiser, whereas these with the nonclassic sort might not want medicine perpetually — if in any respect.
When you’ve got CAH, you might have to take extra glucocorticoids throughout instances of bodily stress, akin to after an damage or when sick. That is known as “stress dosing.” Your physician gives you directions about utilizing greater and extra frequent hydrocortisone doses. Or, in case you’re unable to take oral medicines, they could prescribe an injectable type of glucocorticoids, together with intravenous fluids, in case you go to pressing care, says Speiser.
Different Medicine Concerns for Girls
Some girls who’ve nonclassic CAH may additionally be given different remedies, together with:
- Oral contraceptives, to assist regulate intervals and deal with zits and facial hair
- spironolactone (Aldactone), to assist deal with zits and facial hair
- Corticosteroids, to assist with fertility and reduce the danger of miscarriage
