prednisolone is preferred in infancy and childhood, and prednisone or dexamethasone are often more convenient for adults. The glucocorticoid dose is typically started at the low end of physiologic replacement (6–12 mg/m2) but is adjusted throughout childhood to prevent both growth suppression from too much glucocorticoid and androgen escape from too little. Serum levels of 17α-hydroxyprogesterone, testosterone, androstenedione, and other adrenal steroids are followed for additional information, but may not be entirely normalized even with optimal treatment. (See Glucocorticoid for more on this topic.) However, the currently used glucocorticoid therapy methods may lead to unphysiological doses that, in addition to the problems caused by overexposure of androgens, can harm health. Various clinical results, besides the steroids, require regular monitoring. The negative consequences are primarily the result of non-physiological glucocorticoid replacement. During illness or physical or mental stress, the demand for cortisol can increase, sometimes leading to adrenal crises. As current glucocorticoid therapy regiments fail to replicate the physiologic circadian rhythm and the glucocorticoids are often administered at a higher dose to treat androgen excess, the long-term consequences of the therapy, such as decreased bone density and an increased cardiometabolic risk profile, should be addressed; other consequences of CAH such as impaired quality of life and affected mental health should be taken into consideration; periodic assessments and monitoring of patients should take place in specialized centers to detect and treat potential complications early. Clinical studies are underway to find ways to better mimic the normal circadian rhythm of cortisol secretion and to reduce the total dose of glucocorticoids. Mineralocorticoids are replaced in all infants with salt-wasting and in most patients with elevated renin levels. Fludrocortisone is the only pharmaceutically available mineralocorticoid and is usually used in doses of 0.05 to 2 mg daily. Electrolytes, renin, and blood pressure levels are followed to optimize the dose. Stress coverage, crisis prevention, parental education Even after diagnosis and initiation of treatment, a small percentage of children and adults with infancy or childhood onset CAH die of adrenal crisis . Deaths from this are entirely avoidable if the child and family understand that the daily glucocorticoids cannot be allowed to be interrupted by an illness. When a person is well, missing a dose, or even several doses, may produce little in the way of immediate symptoms. However, glucocorticoid needs are increased during illness and stress, and missed doses during an illness such as the "flu"