Excessive glucocorticoid administration can also lead to short term complications. A recent study has shown that children with CAH have increased BMI compared to their peers, as well as increased insulin resistance. These comorbidities can lead then to metabolic syndrome, as well as the long term effects that are seen in adults.

So optimizing control with hydrocortisone and fludrocortisone is very difficult. We use the androstenedione to help guide us. There is a wide range of normal for androstenedione. Our goal is not necessarily to suppress the androstenedione, but to keep it in the normal to upper normal range. Too much hydrocortisone leading to suppression of androstenedione can then lead to increased risk for bone mineral density decreases, decreased rate of growth, and other morbidities associated with adrenal excess.