Aims: This case study aims to describe the management of Non-Classical Congenital Adrenal Hyperplasia (NC-CAH) in a 37-year-old Iranian female, Mrs. M H, focusing on the challenges of fertility and pregnancy management. The goal is to provide insights into the effective use of glucocorticoid therapy to manage hyperandrogenism and improve fertility outcomes.
Methods: The patient, diagnosed with NC-CAH at age 28 following multiple miscarriages, was managed with glucocorticoid therapy. Her diagnosis was confirmed through genetic testing, revealing compound heterozygous CYP21A2 gene mutations. Serial pregnancies were managed with different glucocorticoids: hydrocortisone in her first pregnancy, dexamethasone post-first pregnancy for hirsutism, and prednisone during her second and third pregnancies. Throughout her pregnancies, the patient’s androgen levels were monitored, and glucocorticoid dosages were adjusted accordingly.
Results: The patient successfully conceived and carried to term three pregnancies with the aid of glucocorticoid therapy. Her first pregnancy resulted in the birth of a healthy male child while on low-dose hydrocortisone. Post-pregnancy dexamethasone treatment effectively managed her hirsutism. During her second and third pregnancies, prednisone was used to manage hyperandrogenism, resulting in the birth of a healthy female child and a currently ongoing pregnancy. The patient's androgen levels were well-controlled during treatment, and stress dosing during labor ensured safe delivery.
Conclusion: Glucocorticoid therapy plays a critical role in managing fertility and pregnancy in women with NC-CAH. Early diagnosis, regular monitoring, and multidisciplinary management are essential for optimizing outcomes. This case underscores the importance of personalized glucocorticoid regimens to control androgen levels, prevent miscarriages, and support successful pregnancies. Genetic counseling for partners and stress dosing during labor are also vital components of care.