[Clinical significance of plasma renin, testosterone, 17-alpha-hydroxyprogesterone and ACTH activities in the treatment of congenital adrenal hyperplasia due to 21-hydroxylase deficiency. A review of 31 cases].
Measurements of urinary steroids do not allow a precise supervision of the evolution and treatment of congenital adrenal hyperplasia due to 21-hydroxylase deficiency. Thirty-one cases with a 2 year follow-up allowed a trial of estimation of the progress that could be obtained with plasmatic dosages of renine, testosterone, A.C.T.H. and 17-hydroxyprogesterone (17-O.H.P.) activities. The best way for reaching diagnosis is presently 17-O.H.P. However, the amplitude and variability of nyctemeral changes of 17-O.H.P. as well as A.C.T.H. activities do not allow to use these two dosages for a precise supervision of therapeutic effects. On the contrary, the dosage of testosterone allows the appreciation of the risk of virilization and its reliability gives a precise control of the effects of steroid therapy. The dosage of the renine activity disclosed unknown or not well controlled sodium-losses, and allowed to adjust the dosage of 9-alpha-fluorohydro-cortisone, while limiting glucocorticosteroids. It gave also evidence of the usefulness of prolonged steroid therapy until the end of the growth period.