BEYOND CONCEPTION: GLUCOCORTICOID BURDEN IN WOMEN WITH NONCLASSIC CONGENITAL ADRENAL HYPERPLASIA

Dear Editor,We read with great interest the review by Çetin and Burak entitled “Latest advances for treating congenital adrenal hyperplasia due to 21-hydroxylase deficiency,” published in Volume 88, Issue 2 of the Journal of Istanbul Faculty of Medicine. The authors highlight emerging strategies designed to control adrenal androgen excess while reducing supraphysiological glucocorticoid exposure, a central therapeutic challenge in classic congenital adrenal hyperplasia (CAH) (1). We would like to extend this discussion to a related but less explored clinical problem: women with nonclassic congenital adrenal hyperplasia (NCCAH) who are pursuing pregnancy.Unlike classic CAH, NCCAH does not usually require lifelong glucocorticoid replacement. The Endocrine Society recommends against glucocorticoid treatment in asymptomatic nonpregnant individuals with NCCAH, but suggests treatment in adult women with clinically important hyperandrogenism or infertility; in women with infertility or previous miscarriage, a glucocorticoid that does not traverse the placenta is recommended (2). Cohort studies further suggest that glucocorticoid therapy may improve reproductive outcomes in selected women with NCCAH (3, 4).