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Beyond its hormonal and metabolic implications, CAH has been increasingly associated with an elevated risk of cardiovascular complications, including endothelial dysfunction, a critical precursor to atherosclerosis and a risk factor for cardiovascular and metabolic diseases. This review explores the current knowledge on endothelial function in patients with CAH, focusing on the interplay between chronic hormonal imbalance, prolonged glucocorticoid treatment, and associated metabolic disorders. We also discuss <jats:italic>in vivo<\/jats:italic> methods for assessing endothelial function alongside the potential utility of novel biomarkers, which may facilitate earlier identification of vascular dysfunction and stratification of cardiovascular risk. 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