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Updated on July 21, 2025
Congenital adrenal hyperplasia (CAH) is a group of genetic disorders that disrupt the normal production of two hormones produced by the adrenal glands, cortisol and aldosterone. CAH also causes excess production of hormones called androgens.
The severity of the condition varies from person to person. Mild cases may not require treatment or may only require minimal treatment. More severe cases can cause life-threatening complications and require continuous therapy with steroid medications—glucocorticoids to treat low cortisol and mineralocorticoids to treat low aldosterone. Steroid therapy also reduces excess androgen production.
Non-steroid treatment for CAH
In addition to steroid medications, a treatment plan for CAH may include other medications, such as salt replacement medications, medications to treat side effects, and newer medications that reduce steroid requirements.
Salt replacement therapy
With salt-wasting forms of CAH, low levels of the hormone aldosterone result in excessive sodium loss. This can result in symptoms like low blood pressure and irregular heartbeat, and complications like severe dehydration. Treatment can include salt replacement medications to restore sodium levels and electrolyte balance. Dietary changes may also be recommended.
Medications to treat side effects
While steroid medications are necessary to treat CAH and can prevent life-threatening complications, steroid medications can also cause unwanted side effects, such as weight gain, metabolic dysfunction, and bone loss. People on long-term treatment with steroid medications may require additional medications to manage these side effects.
Medications to reduce steroid requirements
Medical researchers are working on new therapies to treat CAH. An important focus of research is therapies that can reduce the dosages of steroids required to control androgen production. The goal of reducing steroid dosages is to reduce the side effects associated with long-term steroid therapy, like those described above. One medication that reduces steroid requirements became available in 2024, and others are under development.
Medications for high blood pressure
While low-aldosterone/salt-wasting forms of CAH are more common, there are forms of CAH that cause an excess of mineralocorticoid activity. Instead of causing low blood pressure, these forms will cause hypertension, or high blood pressure. This results from high levels of sodium in the blood and low levels of potassium. A person with this type of CAH will require medications to reduce sodium while maintaining potassium.
Oral contraceptives
Oral contraceptives that contain estrogen and progestin are sometimes prescribed in the treatment of CAH where symptoms are mild. This type of oral contraceptive can help reduce some symptoms caused by androgen excess.
Mental health and social support
Mental health and social support are also considered essential parts of a treatment plan. People with rare disorders like CAH often face challenges that can affect mental health, and some studies have found that people with CAH may be at a greater risk for depression and anxiety. However, this is an area where more research is needed.
Even without symptoms of a mental health disorder, living with a chronic health condition like CAH is often challenging, and things like counseling and support can make a difference to a person’s quality of life.
Here are some strategies to consider:
- Talk to your healthcare providers about how you are doing, including things like sleep, moods, stress levels, and anything that is concerning or challenging.
- Consider participating in a support group for people with CAH or families affected by CAH. This can be a support group that meets online or in person. Support groups and resources are another topic to discuss with a healthcare team.
- Consider working with a mental health professional or counselor, a healthcare provider who can guide you on strategies for coping with stress and the challenges of living with CAH.
Day-to-day, it’s important to make time to take care of yourself. Eating well, exercising, practicing good sleep routines, and avoiding things like alcohol and tobacco are important whether you are a person with CAH or a caregiver. Finding time to relax and do things you enjoy are also good for mental health. You might also consider taking part in mindfulness activities such as yoga, meditation, or breathing exercises.
