re: Labels
Sep. 2nd, 2002   1:06pm
I agree with Megan.  Over time, I’ve come to think that it is partly a problem with how people are "labeled" that produces so much confusion about what type of CAH someone actually has, and why some non-sw’s are treated with florinef, and some aren’t, etc.
 
It seems to me that the terms "non-classic" or "late-onset" are often applied to ANYONE who isn’t diagnosed at birth, with salt-wasting CAH. In fact, I think many of those people may actually be simple-virilizers.  In other words, they are may be late-diagnosed, but not necessarily have late-onset CAH.
 
To add to the name confusion, when you see the terms "non-saltwasting" or "non-salt-loosing" in the medical literature, they generally refer to simple-virilizing CAH.  But the terms are so ambiguous that it is easy to see how one could think it refers to ANY form of CAH that does not produce classic salt-wasting. In addition, the terms themselves are so close to "non-classical" that it becomes even easier to confuse them.  I don’t think parents and patients are the only ones who confuse the terminology.  I think doctors do, too.
 
I think that is the reason why some so-called non-classic or late-onset individuals end up on florinef.  Dollars to donuts, many of those individuals are actually simple virilizers, probably diagnosed in early childhood with accelerated growth or precocious puberty issues.  When you are a simple-virilizer, florinef may or may not be needed.  Adrenal crises do not occur as readily as those with salt-wasting CAH, and electrolyte levels are normal, but plasma renin can be elevated.  If that is the case, control may be difficult, unless florinef is added.
 
Carol M.
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