How should glucocorticoid and mineralocorticoid replacement be optimised in a young patient with classic 21-hydroxylase congenital adrenal hyperplasia?

Glucocorticoid excess is a significant clinical problem in patients with classical 21-hydroxylase deficiency (21OHD) managed in adult practice.

• Clinical inertia contributes to glucocorticoid excess in these patients.
• The article specifically addresses the adult endocrinologist encountering the patient with 21OHD at transition with 'fresh eyes'.
• The paper focuses on young adults and adult patients, representing a population at particular risk of ongoing over-treatment.

Optimisation of both glucocorticoid and mineralocorticoid replacement requires a structured clinical approach in patients with classical 21OHD.

• The article presents a 'simple clinical approach' to steroid supplementation in this population.
• Both glucocorticoid and mineralocorticoid replacement are addressed as components requiring optimisation.
• The approach targets the transition period when adult endocrinologists first manage these patients.
• 21OHD secondary to 21-hydroxylase deficiency is the specific condition addressed.

The transition from pediatric to adult care is identified as a critical juncture for reassessing steroid replacement regimens in classical 21OHD.

• Adult endocrinologists meeting the patient 'with fresh eyes' at transition are specifically identified as the target audience.
• The transition period represents an opportunity to address established patterns of glucocorticoid excess.
• Clinical inertia is identified as a barrier to appropriate dose adjustment at and after transition.