HORMONAL MONITORING AND SIDE EFFECTS OF PRENATAL DEXAMETHASONE (DEX) TREATMENT FOR 21-HYDROXYIASE DEFICIENCY CONGENITAL ADRENAL HYPERPIASIA (CAH)

Abstract

Maternal Dex therapy for fetal CAH at 1-1.5 mg daily initiated between 5-8 weeks gestation and continued to birth, resulted in normal genital outcome, mild virilization, and significant genital virilization in the three CAH newborns treated, and significant side effects in the three mothers, including excess weight gain (9-26 Ibs greater at 35-37 weeks gestation compared to previous full-term pregnancies), glucose intolerance, facial hirsutism, and Cushingoid features including moon-face, plethora, markedly discolored striae on arms, abdomen, breast, and thighs, which resulted in permanent scarring. In addition, hypertension, epigastric pain, and emotional lability were noted, but not consistently. Amniotic fluid 17-OH Progesterone, androstenedione, and testosterone, were elevated in all three Dex treated cases. Maternal EI level was consistently suppressed in the case with the normal genital outcome, and were initially unsuppressed in the cases with mild and severe genital virilization. Conclusion: Dex therapy for prenatal treatment of CAH at a dose of 1-1.5 mg daily was associated with significant maternal side effects. Amniotic fluid steroid levels may not be useful, while maternal serum E1 level may be useful for therapeutic monitoring of fetal CAH, this however requires further investigation.