The treatment strategy for congenital adrenal hyperplasia is burdensome and had not changed in more than 70 years until the ...

MR = Mineralocorticoid receptor; PR = Progesterone receptor. The relative binding affinity (%) of the main progestins discussed in this paper for the different steroid receptors is indicated.

[24] On contact with the receptor, the steroid-receptor complex translocates ... the systemic agents with the least mineralocorticoid activity (sodium and water retention) should be used.

The primary naturally occurring mineralocorticoid is aldosterone ... as the time of onset is similar [4]. Inhaled steroids, like budesonide, have different indications and evidence.

“There are a lot of options. Start with the saline and move to the steroid spray. If you need the antihistamine, you can use that as well, but your primary care provider is here if you need them.