Cognitive function in congenital adrenal hyperplasia

Cognition is affected in beneficial and harmful ways in patients with congenital adrenal hyperplasia (CAH), although cognitive changes are not as well documented as other behavioral changes in these patients. Patients with salt-wasting (SW) and simple virilizing (SV) CAH have at least average intelligence, although IQ may be somewhat lower in SW- than SV-CAH patients. Patients with CAH do not seem to be at special risk for learning disabilities, but this issue requires further study, as does the possibility that they may be likely to have specific learning problems. Girls and women with CAH seem to have enhanced spatial ability as a result of exposure to high levels of androgens early in development, and interesting ongoing studies are concerned with the neural substrate of this advantage, and whether androgen also affects other abilities. There is increasing concern, but little study, of the possibility that patients with CAH may have other cognitive changes as a consequence of disease characteristics, such as salt-losing and hypoglycemic events, and of the treatment of the disease, especially glucocorticoid excess, and that these are reflected in brain changes (including white-matter abnormalities).