Recognition
- Classic salt-wasting (newborns): Vomiting, dehydration, hyponatremia, hyperkalemia, failure to thrive — adrenal crisis within first weeks of life if untreated
- Classic simple virilizing: Female infants with ambiguous genitalia. Males appear normal at birth but develop early puberty
- Non-classic (late onset): Females present with hirsutism, irregular menses, acne, and a PCOS-like picture. Males with acne, premature puberty, and reduced fertility
- Short stature in adults: Androgen-driven premature epiphyseal closure in undertreated childhood CAH
- Clients on hydrocortisone and fludrocortisone replacement: Confirms active disease management
MT Relevance
- Adrenal crisis precautions are the primary safety concern — identical to Addison disease. Confirm the client has taken their hydrocortisone before the session. Recognize adrenal crisis (sudden hypotension, nausea, confusion) as a 911 emergency.
- Orthostatic hypotension: Common with mineralocorticoid deficiency — use slow repositioning. Monitor for dizziness
- Long-term hydrocortisone effects: Skin thinning, easy bruising, reduced bone density (osteoporosis) — reduce pressure. Avoid deep compression over bony prominences. Avoid aggressive percussion
- General massage is well-indicated in stable, well-managed CAH — stress reduction supports cortisol regulation and psychological wellbeing
- Children with CAH: Parental or guardian consent. Age-appropriate communication. Shorter sessions, gentle techniques
- Refer if the client reports increased salt craving, unusual fatigue, or new dizziness — may indicate suboptimal mineralocorticoid replacement
Required Actions
- Adrenal crisis signs (sudden hypotension, nausea, confusion, collapse): Call 911; administer client's emergency hydrocortisone if available
- Client has not taken hydrocortisone: Postpone the session until medication is taken
- New salt craving, unexplained fatigue, or dizziness: Refer to endocrinologist — possible dose adjustment needed
Key Takeaways
- CAH is a congenital enzyme deficiency in cortisol synthesis resulting in adrenal hyperplasia and androgen excess
- The primary MT safety concern is adrenal insufficiency: cortisol-dependent stress response is compromised — same precautions as Addison disease
- Adrenal crisis (sudden hypotension, nausea, confusion) is a 911 emergency in CAH clients on hydrocortisone
- Long-term corticosteroid replacement causes skin thinning, bruising, and osteoporosis — reduce pressure accordingly
- Stable, well-managed CAH is compatible with regular massage. Align treatment with medication timing