Salivary 17-hydroxyprogesterone (17-OHP) and androstenedione in monitoring efficacy of treatment among Indonesian Congenital Adrenal Hyperplasia Patients

Abstract

Objective. Early diagnosis of congenital adrenal hyperplasia (CAH) and the need for long term treatment are of great concern to the medical community. The aim of this study was to evaluate the effectiveness of glucocorticoid treatment-monitoring based on salivary 17-hydroxyprogesterone (17-OHP) and androstenedione measurements in CAH patients in Semarang, Indonesia in comparison to patients treated in Rotterdam, the Netherlands. Methodology. 25 out of 43 patients with CAH from Semarang, Indonesia were included in the study. For comparison, twenty CAH patients from the Sophia Children’s Hospital/ Erasmus Medical Center Rotterdam, the Netherlands were included. The effects of treatment were monitored by estimations of the steroids 17-OHP and androstenedione in saliva. Auxology and bone age determination were recorded. Result. 17-OHP and androstenedione levels were high in a substantial number of Indonesian patients under treatment but decreased after adjustment of dosage and timing. The steroid concentrations obtained after adjustment were similar to those found under comparable circumstances in patients in Rotterdam. Conclusion. Optimal treatment of CAH patients in Semarang Indonesia can be reached by introducing hydrocortisone treatment and adjusting dosage and timing on the basis of salivary steroid monitoring. However, in Indonesia the management of these patients is still constrained by the lack of diagnostic and therapeutic means.