What question did this study set out to answer?

The study aims to assess the knowledge, attitudes, and practices of Chinese endocrinologists concerning congenital adrenal hyperplasia, particularly in fertility management.

March 31, 2026Open Access

Knowledge, attitudes, and practices of Chinese endocrinologists on congenital adrenal hyperplasia: emphasis on fertility management and diagnostic challenges

Key Points

The study aims to assess the knowledge, attitudes, and practices of Chinese endocrinologists concerning congenital adrenal hyperplasia, particularly in fertility management.
Conducted a cross-sectional survey with a questionnaire distributed to 475 endocrinologists.
Used a 70% maximum score threshold to evaluate KAP levels descriptively.
Identified factors associated with KAP through multivariate logistic regression analysis.
Median knowledge score was 21/27, attitudes score was 35/40, and practices score was 28/35.
About 30% of endocrinologists did not recognize that female CAH patients could have natural pregnancies.
24% failed to see fertility preservation as a key treatment goal.
Only 53.9% reported confidence in diagnosing enzyme deficiencies related to CAH.

Abstract

Introduction This study aimed to evaluate the knowledge, attitudes, and practices (KAP) of Chinese endocrinologists regarding congenital adrenal hyperplasia (CAH), which is essential for enhancing clinical differentiation skills and improving fertility management in non-classic CAH patients. Methods This cross-sectional study was conducted between July 27 and August 23, 2023, using a questionnaire distributed to 475 endocrinologists across China. KAP levels were assessed using a 70% maximum score threshold for descriptive purposes, and factors associated with KAP were identified via multivariate logistic regression. Results The median scores were 21/27 (knowledge), 35/40 (attitudes), and 28/35 (practices). Despite positive attitudes, significant gaps in fertility-related knowledge were evident: nearly 30% of respondents failed to recognize that female CAH patients could achieve natural pregnancy through proper individualized treatment, and 24% failed to identify fertility preservation as a key treatment goal. Diagnostic confidence was also limited (53.9%), with over half of participants unclear on the most common enzyme deficiencies crucial for differential diagnosis. Logistic regression analysis revealed that having a doctoral degree, an intermediate or senior professional rank, and experience in diagnosing CAH were associated with more proactive clinical practices, especially in patient education and reproductive health counseling. Conclusion While Chinese endocrinologists demonstrate generally positive attitudes toward CAH, significant knowledge and practice gaps persist, particularly in fertility management and diagnostic differentiation. The limited awareness of reproductive outcomes and low diagnostic confidence highlight an urgent need for targeted education to improve individualized fertility treatment options and reduce misdiagnosis in clinical practice.

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