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Comparison of different glucocorticoid regimens in the management of classical congenital adrenal hyperplasia due to 21-hydroxylase deficiency.
[congenital adrenal hyperplasia]
There
are
recommendations
regarding
the
total
dose
of
hydrocortisone
to
be
administered
in
the
treatment
of
classical
congenital
adrenal
hyperplasia
(
CAH
)
to
achieve
the
twin
objectives
of
glucocorticoid
replacement
and
control
of
hyperandrogenism
.
However
,
there
is
evidence
gap
regarding
the
breakup
,
timing
and
type
of
the
steroid
regimen
.
E
fficacy
of
three
different
glucocorticoid
regimens
having
the
same
total
dose
of
steroid
,
differing
in
either
the
timing
or
type
of
evening
steroid
administered
,
in
achieving
biochemical
control
of
the
disease
was
assessed
.
The
study
was
done
in
13
prepubertal
children
with
classical
CAH
over
a
6
-
month
period
with
2
months
devoted
to
each
regimen
.
We
used
a
prospective
cross-over
design
using
10
-
15
mg
/
m
(
2
)
total
dose
of
hydrocortisone
.
Two
-fifths
of
the
total
dose
of
hydrocortisone
was
administered
in
the
morning
and
one
-
fifth
of
the
total
dose
was
administered
at
noon
in
all
the
regimens
.
The
regimens
differed
in
the
timing
of
the
evening
dose
of
hydrocortisone
,
06
.
00
-
07
.
00
pm
in
regimen
1
and
09
.
00
-
10
.
00
pm
in
regimen
2
.
The
third
regimen
had
the
evening
dose
of
hydrocortisone
replaced
by
an
equivalent
dose
of
prednisolone
suspension
which
was
administered
at
10
.
00
pm
.
Serum
17
-
hydroxyprogesterone
and
testosterone
levels
were
compared
to
assess
the
efficacy
of
treatment
regimens
.
The
three
different
regimens
were
found
to
be
similar
in
their
ability
to
control
17
-
hydroxyprogesterone
and
testosterone
levels
.
The
percentage
of
patients
with
predefined
criteria
for
biochemically
controlled
disease
was
similar
in
all
the
three
regimens
.
However
,
there
was
a
trend
toward
better
control
of
17
-
hydroxyprogesterone
levels
in
patients
receiving
evening
dose
of
prednisolone
.
There
is
no
significant
advantage
in
administering
the
hydrocortisone
dose
late
at
night
in
patients
with
classical
CAH
.