Table 1.

Current oral glucocorticoid and mineralocorticoid preparations in the management of classic CAH

Formulation	Duration of action (hours)	Dose and frequency (daily)	Comments
Short-acting glucocorticoid
Hydrocortisone	6–8	Children: 10–15 mg/m2 per day split over three to four doses. Fully grown children and adults: 15–25 mg per day, split over two to three doses	Preferred in growing children
Intermediate-acting glucocorticoid
Prednisone	12–36	Adults: 5–7.5 mg per day, split over two doses	NA
Prednisolonea	12–36	Adults: 4–6 mg per day, split over two doses	NA
Methylprednisolone	12–36	Adults: 4–6 mg per day, split over two doses	NA
Long-acting glucocorticoid
Dexamethasoneb	36–54	Adults: 0.25–0.5 mg per day, split over 1–2 doses	To improve and maximize adherence; to treat adrenal rest; this drug should be avoided in individuals who can become pregnant because it traverses the placenta during pregnancy
Mineralocorticoid
Fludrocortisonec	18–36	Children and adults: the usual starting dose is 0.1 mg per day (range 0.05–0.2 mg per day), split over 1–2 doses	Requirements are higher in the newborn period than in other periods owing to the physiological resistance of the kidneys to mineralocorticoid

CAH, congenital adrenal hyperplasia; NA, not applicable. ^aActive form not requiring 11β-hydroxysteroid dehydrogenase 1 (11βHSD1) conversion. ^bLacks mineralocorticoid activity. ^cPossesses glucocorticoid activity (10–15 times more potent than hydrocortisone)⁴⁶.