Congenital adrenal hyperplasia in adulthood: do men need to continue treatment?

Due to early diagnosis and appropriate paediatric treatment, internists and endocrinologists are now caring for an increasing number of adult patients with congenital adrenal hyperplasia (CAH). Problems that may be encountered in adult males with CAH are the continuing risk of developing an adrenal crisis and impaired gonadal function due to suppression of the hypothalamic-gonadal axis. Fertility may be further compromised by testicular adrenal rest tumours. Available data suggest that the reversal of infertility is more difficult once testicular nodules have developed. Similar to female CAH patients, male patients may develop adrenal tumours due to inadequate adrenocorticotropic hormone suppression. We therefore recommend continuous treatment of male CAH patients with careful monitoring of clinical and hormonal parameters in order to avoid overtreatment.