Effects Of Steroid Medication

The steroid medications used in treating CAH include a glucocorticoid, such as hydrocortisone, and a mineralocorticoid, such as fludrocortisone.

Glucocorticoids, when taken in excess, will cause the condition called Cushing’s syndrome. The symptoms of this syndrome include excessive weight gain and poor growth in a child. Quite characteristically, there is a round, ‘moon face’, with fatty deposits that tends to accumulate in the upper back (buffalo hump) and trunk (truncal obesity), rather than in the arms and legs, because there are more glucocorticoid receptors in the truncal and abdominal fat.

Other features of Cushing’s syndrome include increased fine hair over the face, trunk and peripheries (hirsutism and hypertrichosis), forehead acne, thick purple streaks (striae) over the lower abdomen, buttocks, upper thighs or arms, increased weakness in the thigh muscles, especially when climbing the stairs (proximal myopathy), and hypertension. Excessive steroid ingestion can also cause decreased mineralisation of the bone with osteoporosis, and the occasional effect on psychological and cognitive processes, ranging from fatigue, irritability, crying, depression to euphoria.

Mineralocorticoids helps in the retention of salt. When taken in excess it may lead to fluid retention, and may contribute to the development of hypertension as well.

If a CAH child is treated with excessive steroids, the weight gain will be progressively excessive, with little gain in height. Conversely, if he is under-treated with steroids, there is a loss of weight as a result of increased urinary salt loss, and he will experience a growth spurt because of the accumulation of adrenal androgens which cause virilisation. In boys, there is early or precocious puberty. In girls, there will be the development of male characteristics such as a deepening of
the voice and increased hairiness.

The aim in treatment of CAH is the physiological replacement of glucocorticoids and mineralocorticoids, which are deficient. The dosage of both medications must first be titrated against the body weight, as children are constantly growing. Fine tuning of the medication dosage will be performed by the doctor, who will adjust the dose according to the blood test results of the 17-Hydroxyprogesterone and plasma renin activity. Adequate replacement with the correct doses of both hormones at different stages of a child’s development, should result in normal growth, and normal pubertal development.