The goal of CAH treatment is normalization of cortisol levels and ideally also of sex-steroid levels. Traditionally, OHPG and urinary pregnanetriol or total ketosteroid excretion are measured to guide treatment, but these tests correlate only modestly with androgen levels. Therefore, androstenedione and testosterone should also be measured and used to guide treatment modifications. Normal prepubertal levels may be difficult to achieve, but if testosterone levels are within the reference range, androstenedione levels of up to 100 ng/dL are usually regarded as acceptable.
Plasma 17-hydroxyprogesterone (17-OH-P) was determined by two commercially available immunoassay k kits, a radioimmunoassay (RIA) (OHP-CT, CIS) and an enzyme-immunoassay (EIA) (Serozyme 17 α-OH-progesterone, Serono). The determination by RIA was performed according to two procedures, directly on plasma or on a crude plasma extract, whereas that by EIA used only the second procedure. These determinations were carried out in 27 infants below 1 year of age and in 33 women in the follicular phase of the menstrual cycle. The results were compared to those obtained by an in-home RIA (RIA-FRH) which includes an extraction step followed by chromatography on Sephadex LH 20 column. The levels observed were overestimated by both kits. In infants, interference from 17-hydroxy-pregnenolone (17-OH-5P) sulfate occurred when the RIA (CIS) kit was used directly on plasma samples. Using plasma extracts, 17-OH-5P interfered with EIA (Serono) in the infant group and with the RIA (CIS) in the second group. The two kits do not appear to be adequate for 17-OH-P determination at least in infants and in women in the follicular phase of the menstrual cycle.
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