Endocrine Abstracts

Congenital adrenal hyperplasia (CAH) remains a challenging condition to manage during adolescence due to the limitations of current treatments. A major issue is the inability to adequately suppress early morning androgen surges, requiring supraphysiological doses of glucocorticoids (GC) to suppress ACTH. This can lead to both over- and undertreatment throughout the day, particularly in childhood, where the available preparations are suboptimal. Adolescents with CAH are at risk of various complications. These include adrenal crises, salt-wasting crises, mainly due to noncompliance which can be life-threatening. Elevated androgens due to poor hormonal control may result in precocious puberty, pubertal disturbances, delayed menarche, and ultimately, a reduced final adult height. Additionally, gonadal dysfunction and testicular adrenal rest tumors (TART) are frequently described. Furthermore, mental health challenges can significantly impact quality of life. Despite advances in treatment, no curative therapy exists for CAH, and glucocorticoid therapy remains the mainstay of management. However, balancing effective androgen suppression while avoiding GC-related side effects remains difficult. The risk of adrenal crises persists, necessitating careful monitoring and education on stress-dose adjustments. Modified-release glucocorticoids offer a potential strategy to better mimic physiological cortisol rhythms and improve HPA axis suppression, but optimal treatment regimens in adolescence are still under investigation. Future advancements should focus on improving disease control while minimizing long-term complications and enhancing quality of life.