Endocrine Abstracts

Introduction: Antenatal treatment with dexamethasone in pregnancies affected by congenital adrenal hyperplasias (CAH) therefore suppresses fetal androgen production and prevents virilisation of female infants. Antenatal DXM is reported to be efficacious, preventing or ameliorating virilisation in 80–85% of cases.

Case report: 23-year-old patient pregnant at 6 weeks, not known of having congenital adrenal hyperplasia (CAH), concept of consanguineous marriage 1 degree; she had a history of 2 children followed up for a classic form of HCS, the first died at the age of 1 and 10 months and the 2 child died on D26 of life. After having made a prenatal diagnosis where an analysis of the SRY gene on fetal circulating DNA showed the absence of this gene, which confirms the female sex of the fetus. An obstetrical ultrasound was done which objectified a pregnancy estimated at 6 weeks with suspicion of clitoral hypertrophy (At 16 weeks), in view of this observation the patient was referred to us for additional care and possible dexametasone. On questioning, the patient did not report any signs of hyperandrogenism. All evolving in a context of unquantified moderate weight loss and asthenia without signs of adrenal insufficiency. The clinical examination showed no melanoderma or slate spots, BP= 105/71mmHg, RR = 19 cycles/min. CF=81bpm? BMI = 28.68 kg/m2. Tanner: S5P5. the patient was put on 1.5 mg/d of dexamethasone divided into 3 doses. A monthly measurement of DHEAS and cortisol was requested. The Decrease of plasma concentrations of cortisol and DHEAS in the mother testifies to good fetal adrenal suppression. A low-calorie diet and monitoring of blood pressure and blood sugar to detect signs of under or overdose of corticosteroid therapy. Ultrasound monitoring of the fetus done each month, the first ultrasound done 1 month after Dexamethasone treatment shows the disappearance of the clitoral hypertrophy seen on the initial ultrasound. patient gave birth at 38 weeks of amenorrhea by caesarean section, the newborn is female, the birth weight is 2 Kg 600, the external genitalia are normal The newborn was hospitalized in the neonatology department for monitoring and screening of The congenital adrenal hyperplasia.

Conclusion: CAH is an uncommon but important and ethically complex condition where there are significant maternal and fetal risks both with and without antenatal treatment. It is time for the historical recommendation of administering prenatal DXM to all pregnancies of high-risk families for CAH to be reevaluated.