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Abstract and Introduction
Introduction
The management of congenital adrenal hyperplasia (CAH) is complex requiring a careful balance of glucocorticoid and mineralocorticoid replacement therapy set against background changes within other hormonal systems, such as the hypothalamo-pituitary-gonadal axis. Several guidelines have been devised to assist the clinician. The most recent by the Endocrine Society is comprehensive and constructed using standard criteria for appraisal of evidence. The group charged with constructing the guideline was drawn from a variety of disciplines, including patients and families. The guidelines provide a balanced account of the clinical care that should be provided for children, young people and young adults at the end of the first decade of the 21st century. Differences in healthcare systems often alter the tone, but not necessarily the content of clinical practice guidelines so will these guidelines work outside of North America?
The short answer is yes as there is consensus between the Clayton document and that from the Endocrine Society. There are differences, for example, in the way that monitoring may be undertaken, and this reflects perhaps a lack of evidence concerning the most appropriate modalities for monitoring therapy rather than any disagreement about what should be measured. There are, however, two areas within the report that bear further consideration. The first relates to newborn screening for CAH and the second concerns the use of antenatal treatment with dexamethasone.
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