Figure 4. Patients with salt-losing 21-hydroxylase deficiency. The treatment outcome in classic congenital adrenal hyperplasia is often suboptimal because of incomplete suppression of hyperandrogenism (top), treatment-induced hypercortisolism (bottom), or both. At 16 years of age, a female patient with salt-losing 21-hydroxylase deficiency due to undertreatment with glucocorticoid and elevated androgen levels had hirsutism, acne, amenorrhea, and hyperpigmentation (top). Increased glucocorticoid treatment resulted in weight gain with cushingoid features and short stature in a male patient with classic 21-hydroxylase deficiency (bottom).