LONG term follow-up include clinical laboratory assessment of glucocorticoid and mineralocorticoid
replacement, and control of androgen excess is also evaluated.
- These children are followed up every 3 monthly for the first 3 years of life then every 6 monthly until the completion of growth and pubertal development.
- On follow-up check for height, weight, BMI. Plot on reference curves to ascertainadequate velocity. Subnormal height velocity is suggestive of over treatment andan increased velocity of under treatment.
- High BMI, often seen in these children,is helpful in reinforcing life style modification
- Serum 17-OHP is checked on follow-up visits and more frequently if there is a change of dosing or compliance doubtful. Dose adjustment is made to keep Serum 17-OHP levels at less than 5 ng/mL.
- Assessment of serum electrolyte, plasma renin activity (PRA) is used to titrate the dose of fludrocortisone. Plasma renin activity suppression is avoided as excess fludrocortisone (FC) can lead to hypertension and related problems
- Annual assessment of bone age, pubertal development and testicular examination in boys must be done to evaluate excess androgen effects
- estimation of androsteinedione,dhea,dheas,testosterone>5 months can dx androgen excess
- In adulthood, long-term follow-up in the following areas is recommended:overweight/obesity, bone mineral density, fertility and cardiovascular risks
- Issues regarding gender identity, gender role and sexual orientation must be referred to experts for evaluation and therapy.
Superintendent, ICH.