[Treatment of virilizing adrenal hyperplasia in adolescents. Use and side-effects of dexamethasone].

Dexamethasone (DXM) has been used to reduce clinical and/or biological hyperandrogenism in 18 adolescent patients treated by hydrocortisone and fludrocortisone for congenital virilizing adrenal hyperplasia (CAH). The doses and duration of treatment did vary among these patients. Androgen excess has been suppressed in all cases, even treated with low doses. Side-effects have been noticed in 9 patients, 5 having large purple striae, and 4 having mild and transient hypercortisolism. The analysis of data shows that DXM may be used for the treatment of CAH in pubertal patients provided that its use remains limited to cases in which the usual treatment does not allow to avoid the androgen excess. In such patients, the dose of DXM at the onset of treatment should be 0.25 mg given once a day, at night, and should not exceed 0.5 mg daily; it has to be adjusted according to clinical results, avoiding to obtain subnormal androgen levels. Hydrocortisone and/or fludrocortisone have to be prescribed for short periods in situations of stress, but not as permanent association. Within these limits, DXM may be considered as a valuable means to obtain hormonal adjustment in CAH adolescent patients.