Urinary and serum steroid concentrations in the management of congenital adrenal hyperplasia. Lack of physiologic correlations
S. A. Hendricks, B. M. Lippe, S. A. Kaplan, N. Lavin and D. M. Mayes
Serum concentrations of 17-hydroxyprogesterone, dehydroepiandrosterone,
dehydroepiandrosterone sulfate, progesterone, testosterone, and
androstenedione and 24-hour excretion of 17-ketosteroids and pregnanetriol
were measured serially in 18 children with congenital adrenal hyperplasia
(21-hydroxylase deficiency) during a two-year period. Correlations were
sought between results of measurements of these steroids and clinical
progress assessed by physical examination and skeletal maturity to
determine if measurement of concentration of these substances at a single
point in time could be used to gauge the dose of corticosteroids for
optimum treatment. We found that these measurements of steroids were
generally not useful indicators of optimum control of the disease. Repeated
careful clinical examination and assessment of changes in growth velocity
and skeletal maturation seem to be the best criteria on which to base
dosage of corticosteroids used for therapy.
