{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,6]],"date-time":"2026-02-06T16:41:40Z","timestamp":1770396100459,"version":"3.49.0"},"reference-count":33,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,2,6]],"date-time":"2026-02-06T00:00:00Z","timestamp":1770336000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Endocrinol."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Congenital adrenal hyperplasia (CAH) treatment is complicated by hormonal imbalances, necessitating a dual therapeutic approach to both correct cortisol deficiency and manage androgen overproduction. Unfortunately, hospitals with limited resources lack some necessary standard laboratory tests to manage patients with CAH.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To investigate the interrelation between different monitoring strategies in clinical practice for managing patients with CAH.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This prospective cross-sectional study involved children with CAH caused by 21-hydroxylase deficiency (21-OHD) treated at King Faisal Specialist Hospital and Research Centre. KFSHRC is not resource-limited; the proposed recommendations are intended for settings that lack full biochemical panels. Univariable, bivariable, and multivariable logistic regression were done for association testing.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The cohort included 96 children with 21-OHD, predominantly female (61.5%), with a median age of 6 years. Adrenal crises occurred in 20.8% of patients. Most participants were treated with hydrocortisone (97.9%) and fludrocortisone (88.5%), with high reported treatment compliance (90.6%). Biochemical abnormalities were observed in 26% for ACTH, 21.9% for 17-OHP, and 17.7% for testosterone. Biochemical control was significantly associated with treatment compliance (OR 7.6, p = 0.03). In adjusted analyses, androstenedione, ACTH, and testosterone control were strongly associated with 17-OHP control (all p &amp;lt; 0.01). Regarding skeletal outcomes, older age was inversely associated with bone age control, whereas clinical control (OR 11.1, p &amp;lt; 0.01) and controlled androstenedione levels (OR 3.0, p = 0.04) were independent predictors of optimal bone age.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Based on these findings, we recommend integrating growth velocity monitoring and androstenedione testing into routine visits as valuable indicators for assessing clinical control in 21-OHD children. Yet, larger studies are needed to validate simplified monitoring frameworks for resource-limited hospitals.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fendo.2026.1730774","type":"journal-article","created":{"date-parts":[[2026,2,6]],"date-time":"2026-02-06T05:22:07Z","timestamp":1770355327000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Clinical tools for evaluating congenital adrenal hyperplasia in resource-limited hospitals: a study at a tertiary hospital in Saudi Arabia"],"prefix":"10.3389","volume":"17","author":[{"given":"Daniah","family":"Alhazmi","sequence":"first","affiliation":[{"name":"Section of Pediatric Endocrine\/Metabolism, Department of Pediatrics, King Faisal Specialist Hospital and Research Center","place":["Riyadh, Saudi 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