Management of classic congenital adrenal hyperplasia (CAH), a rare genetic condition diagnosed at birth, requires a careful balance between androgen and cortisol.

Most often caused by a genetic mutation in the 21-hydroxylase enzyme, patients with CAH experience a decrease in cortisol production leading to an increase in androgen production. This disruption causes a downstream effect of multiple hormone imbalances in patients, leading to a myriad of outcomes like infertility, abnormal puberty, and virilization in the patient.

"The overarching goal is to replace deficient hormones, prevent adrenal crises, and control adrenal androgens," said Deborah Merke, MD, MS, of the NIH in Bethesda, Maryland.

Classic CAH management is "challenging," she noted at ENDO 2025, the annual meeting of the E

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