Knowledge, attitudes, and practices of Chinese endocrinologists on congenital adrenal hyperplasia: emphasis on fertility management and diagnostic challenges

Introduction This study aimed to evaluate the knowledge, attitudes, and practices (KAP) of Chinese endocrinologists regarding congenital adrenal hyperplasia (CAH), which is essential for enhancing clinical differentiation skills and improving fertility management in non-classic CAH patients. Methods This cross-sectional study was conducted between July 27 and August 23, 2023, using a questionnaire distributed to 475 endocrinologists across China. KAP levels were assessed using a 70% maximum score threshold for descriptive purposes, and factors associated with KAP were identified via multivariate logistic regression. Results The median scores were 21/27 (knowledge), 35/40 (attitudes), and 28/35 (practices). Despite positive attitudes, significant gaps in fertility-related knowledge were evident: nearly 30% of respondents failed to recognize that female CAH patients could achieve natural pregnancy through proper individualized treatment, and 24% failed to identify fertility preservation as a key treatment goal. Diagnostic confidence was also limited (53.9%), with over half of participants unclear on the most common enzyme deficiencies crucial for differential diagnosis. Logistic regression analysis revealed that having a doctoral degree, an intermediate or senior professional rank, and experience in diagnosing CAH were associated with more proactive clinical practices, especially in patient education and reproductive health counseling. Conclusion While Chinese endocrinologists demonstrate generally positive attitudes toward CAH, significant knowledge and practice gaps persist, particularly in fertility management and diagnostic differentiation. The limited awareness of reproductive outcomes and low diagnostic confidence highlight an urgent need for targeted education to improve individualized fertility treatment options and reduce misdiagnosis in clinical practice.