The treatments for both classic and nonclassic congenital adrenal hyperplasia (CAH) include medication, surgery, and psychological support, or a combination of all three. Some people who have CAH, including men with nonclassic CAH, may not need treatment at all, but this depends on the severity of the condition.
Talk to your doctor before starting treatment or making changes to the treatment plan. If you do take medication, you may have to keep taking it for life.
Medication
If you have classic CAH or nonclassic CAH with symptoms, medications are available to help fix your body’s imbalance of hormone levels — namely, a lack of cortisol and aldosterone and excess androgen. People who have nonclassic CAH without symptoms won’t need treatment.
Medications to treat classic CAH or nonclassic CAH with symptoms include:
Mineralocorticoids
Fludrocortisone (Florinef Acetate) is a steroid medication that replaces the hormone aldosterone. This helps boost development and growth, counter sodium loss, and prevent adrenal crises (a life-threatening emergency that occurs when cortisol and aldosterone levels are too low).
Glucocorticoids (aka corticosteroids or simply steroids) replace the hormone cortisol. This helps manage adrenal insufficiency, control androgen levels, and aid in development and growth. Options include:
dexamethasone
hydrocortisone
methylprednisolone
prednisolone
prednisone
Glucocorticoids can cause side effects such as:
Increased appetite and weight gain
Mood changes
More body hair
Muscle weakness
Risk of infection
Signs of high blood sugar (i.e., feeling hungry or thirsty or urinating more frequently than normal)
In children, glucocorticoids may also cause growth delays, says Phyllis Speiser, MD, a pediatric endocrinologist at Cohen Children’s Medical Center of New York and an associate investigator at the Feinstein Institutes for Medical Research at Northwell Health in Manhasset, New York.
Because of these side effects, “We usually recommend the least long-acting or least potent glucocorticoid, which is hydrocortisone, for daily maintenance,” says Dr. Speiser. “For children, we are especially vigilant about maintaining the lowest possible dose to achieve effective adrenal control.”
The other drugs are used “for situations in which a patient doesn’t respond as expected to the hydrocortisone regimen,” she says.
Corticotropin-Releasing Factor Type 1 Receptor Antagonists
A medication called crinecerfont (Crenessity) is a corticotropin-releasing factor type 1 receptor antagonist that can also be used with glucocorticoids to better control androgen levels in adults and children over age 4 who have classic CAH. This allows for a reduced daily glucocorticoid dose while maintaining control of androgen levels.
The most common side effects of crinecerfont include arthralgia (joint pain), dizziness, and fatigue in adults and abdominal pain, fatigue, and headache in children. But the main concern with crinecerfont is the risk of acute adrenal insufficiency or adrenal crisis.
Salt Supplements
For people with classic salt-wasting CAH, particularly infants, prescription sodium chloride supplements may help with sodium retention.
Medication Considerations
People who take medication for CAH will be monitored regularly, says Speiser. For example, follow-up visits may be:
Every 1 to 2 months for infants
Every 4 to 6 months for children
Every 6 to 12 months for adults
In people with CAH, those with the classic type will need to take medication for life, says Speiser, whereas those with the nonclassic type may not need medication forever — if at all.
If you have CAH, you may need to take more glucocorticoids during times of physical stress, such as after an injury or when sick. This is called “stress dosing.” Your doctor will give you instructions about using higher and more frequent hydrocortisone doses. Or, if you’re unable to take oral medications, they may prescribe an injectable form of glucocorticoids, along with intravenous fluids, if you go to urgent care, says Speiser.
With classic CAH, you’ll need to wear a medical alert identification bracelet or necklace that reads “adrenal insufficiency — requires hydrocortisone.” This alerts medical professionals that you have the condition in the case of an emergency.
Other Medication Considerations for Women
Some women who have nonclassic CAH may also be given other treatments, including:
Oral contraceptives, to help regulate periods and treat acne and facial hair
spironolactone (Aldactone), to help treat acne and facial hair
Corticosteroids, to help with fertility and decrease the risk of miscarriage
Surgery
In classic CAH, infants born with ambiguous genitalia may be candidates for surgery one day. People who are born female and raised as girls, for example, may choose to have surgery to improve urine flow, make intercourse more comfortable, or reduce an enlarged clitoris.
There’s no “right” time to have surgery. Some research shows that parents of girls tend to prefer getting the surgery done in infancy or early childhood, though, rather than waiting to make a decision later in the child’s life.
That said, there are also benefits to waiting. “In the past, people would say that surgery for atypical female genitalia must be done right away,” says Speiser. “But now the thinking has changed so that it’s a matter of shared decision-making. Some families forgo reconstructive surgery in childhood and reserve decisions for when the patient can participate in the decision.”
It’s best to consult a variety of healthcare providers about the pros and cons of surgery and its timing, including a pediatric endocrinologist, surgeon, and urologist. You can find a healthcare provider who specializes in CAH by visiting the Endocrine Society’s physician referral directory.
Any surgery for CAH should be performed at a center that specializes in genitoplasty.
Infants with nonclassic CAH are not born with ambiguous genitalia.
Questions to Ask Your Child’s Doctor
Will my child need to take medication for the rest of their life?
Should we be considering surgery?
What is expected during puberty?
What dose of medication will my child need to take in times of stress?
Will my child be able to get pregnant and have a healthy baby?
Mental Health Treatment
Research shows that CAH has been linked to higher rates of anxiety and depression in young people. If your child has CAH, you may want to seek support from a mental health professional or others either living with CAH or caring for a loved one with the condition.
“Mental health counseling is important for the family as a whole and for the patients themselves,” says Spieser. Some support groups for people with CAH include:
It’s important to work with a doctor to discuss the right medication approach for treating CAH, which can vary based on the type of CAH and symptoms.
For some people with classic CAH, surgery may be considered at some point. A team of healthcare providers can help decide on timing.
Since CAH can be associated with anxiety and depression, a mental health professional may be a good addition to the healthcare team for support.
EDITORIAL SOURCES
Everyday Health follows strict sourcing guidelines to ensure the accuracy of its content, outlined in our editorial policy. We use only trustworthy sources, including peer-reviewed studies, board-certified medical experts, patients with lived experience, and information from top institutions.
Sharma L et al. Congenital Adrenal Hyperplasia. StatPearls. January 27, 2025.
Harasymiw LA et al. Depressive and Anxiety Disorders and Antidepressant Prescriptions Among Insured Children and Young Adults With Congenital Adrenal Hyperplasia in the United States. Frontiers in Endocrinology. August 17, 2023.
Elise M Brett, MD, is a board-certified adult endocrinologist. She received a bachelor's degree from the University of Michigan and her MD degree from the Icahn School of Medicine at Mount Sinai. She completed her residency training in internal medicine and fellowship in endocrinology and metabolism at The Mount Sinai Hospital. She has been in private practice in Manhattan since 1999.
Dr. Brett practices general endocrinology and diabetes and has additional certification in neck ultrasound and fine-needle aspiration biopsy, which she performs regularly in the office. She is voluntary faculty and associate clinical professor at the Icahn School of Medicine at Mount Sinai. She is a former member of the board of directors of the American Association of Clinical Endocrinology. She has lectured nationally and published book chapters and peer reviewed articles on various topics, including thyroid cancer, neck ultrasound, parathyroid disease, obesity, diabetes, and nutrition support.
Maria Masters is a contributing editor and writer for Everyday Health and What to Expect, and she has held positions at Men's Health and Family Circle. Her work has appeared in Health, on Prevention.com, on MensJournal.com, and in HGTV Magazine, among numerous other print and digital publications.
