Journal of Genetic Counseling

, Volume 21, Issue 5, pp 615–624

Prenatal Treatment of Congenital Adrenal Hyperplasia—Not Standard of Care

Commentary

DOI: 10.1007/s10897-012-9508-8

Cite this article as:
Witchel, S.F. & Miller, W.L. J Genet Counsel (2012) 21: 615. doi:10.1007/s10897-012-9508-8

Abstract

Congenital adrenal hyperplasia (CAH) due to steroid 21-hydroxylase deficiency is a common autosomal recessive disorder due to mutations in the CYP21A2 gene. Since genetic counselors play a crucial role in educating families about inherited disorders, they need to have thorough knowledge regarding the pathophysiology of CAH especially the effects on the fetus, the complex genetics of this disorder, and the controversies surrounding experimental prenatal dexamethasone treatment. Affected female fetuses may have varying degree of virilization of the external genitalia. Starting in the 1980’s, supraphysiologic glucocorticoid treatment was used to decrease the virilization of the external genitalia of affected female fetuses. However, recent clinical observations, animal studies and greater awareness of the details of human fetal adrenal physiology raise concerns regarding the safety of this prenatal treatment. We review the pathophysiology of CAH, the safety and ethical considerations of prenatal dexamethasone treatment and the views of multiple medical societies that conclude that this experimental therapy should only be done in prospective trials approved by ethical review boards.

Keywords

Congenital adrenal hyperplasia Ambiguous genitalia Prenatal dexamethasone Prenatal treatment CYP21A2 Ethics 

Copyright information

© National Society of Genetic Counselors, Inc. 2012

Authors and Affiliations

  1. 1.Department of Pediatrics, Division of Pediatric Endocrinology, Children’s Hospital of Pittsburgh of UPMCUniversity of PittsburghPittsburghUSA
  2. 2.Department of Pediatrics, Division of Pediatric Endocrinology, HSE 1427University of California, San FranciscoSan FranciscoUSA