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Congenital Adrenal Hyperplasia (CAH)

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When your child is diagnosed with a rare condition, you want to find the pediatric team with the knowledge and experience necessary to provide your child with the best possible outcome. Cook Children's Congenital Adrenal Hyperplasia program is made up of specialists whose training and years of practice have made them recognized experts in the care of children from birth through adolescence with this condition.

Congenital Adrenal Hyperplasia (CAH) is a complicated genetic disorder that can have a lifelong impact on your child's growth and development.

More Information on CAH


Your Congenital Adrenal Hyperplasia (CAH) team

Because of the complexity of this condition, and the sometimes difficult challenges and decisions facing families, Cook Children's CAH program includes an amazing team of specialists from Urology, Endocrinology, Neonatology, Genetics and more – all to provide the best treatment and family support available.

Our Behavioral Health specialists also provide ongoing support for parents, patients and families to help them cope with the impacts of CAH, and ensure positive outcomes for your child, now and in the future.



Cortney Wolfe-Christensen

Cortney Wolfe-Christensen PhD

Behavioral Health Specialist

Emily Haddad

Emily Haddad LCSW

Behavioral Health Specialist
  • Care Coordinator/ Educator: Shannon Thompson RN

Additional care provided by:

  • Surgery Coordinator: Brittany Mechaca
  • Neonatologist: Jonathan Nedrelow MD
  • Reproductive specialist for males: Robert Kaufmann MD
  • Reproductive specialist for females: Andrea Palmer MD
  • Social worker: Paige Mauch MSW
  • Geneticist: Alexandra Garza-Flores MD
  • Genetic Counselor: Alicia Hernandez PN
  • Nutritionist: Linsay Pyke PN
  • Pediatric radiologist: Adeka McIntosh MD
  • Dermatologists: Bryan Carroll MD; Heather Volkman MD

Our team services 10 different satellite clinics, including Fort Worth, Abilene, Amarillo, Denton, Hurst, Lewisville, Midland, San Angelo, Tyler, Waco. For patients who attend the outlying clinics we have the availability of telemedicine and we offer our patients the opportunity to see their local Cook Children's endocrinologist in the satellite clinic. Once per year, patients come to the congenital adrenal hyperplasia clinic in Fort Worth for a fine tuning of the program and for education and meeting with other families.

Research studies

We have two ongoing studies that include families having a child with congenital adrenal hyperplasia.

Short-term Outcomes of Interventions for Reproductive Dysfunction: Study 1, 2 and 3.

The purpose of this study is to continue to gather much needed information regarding the long-term risks and benefits of genitoplasty procedures currently performed in young children with Disorder of Sex Development (DSD) and Congenital Adrenal Hyperplasia (CAH) as well as the impact of these decisions on behavioral development of affected children and their parents. We would like to examine the child’s bladder control and behavioral development and review any other complications or problems that may have occurred post-surgery. Also, we will review parent adjustments, as these relate to the surgical history. We will assess both parents and children annually until the child reaches age 10.

The sponsor of this study plans to include about 100 participants and 200 parents nationwide in this research project. About 9 children and 17 parents will be enrolled from Cook Children’s Health Care System (CCHCS).

Lastly, we will administer a hearing test measure of an Otoacoustic Emissions (OAE) to determine if there is a relationship between gender development and the results of the hearing test in people with DSD and CAH. The sponsor of this study plans to include about 40 participants nationwide in this research project.

Development of an Internet-Delivered Illness Uncertainty Intervention for Caregivers of Children with a DSD or CAH: A Multi-Center Collaboration.

The purpose of this research is to develop an online program that can be used by parents of children with a Difference of Sex Development (DSD) or Congenital Adrenal Hyperplasia (CAH) to help them cope with their feelings about their child's diagnosis.

The sponsor of this study plans to include about 80 participants nationwide in this research project. About 50 will be enrolled at Cook Children's Medical Center.

Abstracts and papers

Meeting presentations (not published papers)

Bernabé, K. J., Nokoff, N. J., Felsen, D., Galan, D., Aston, C. E., Austin, P., Baskin, L., Chan, Y. -., Cheng, E. C., Diamond, D., Fried, A., Gonzalez, L., Greenfield, S., Kolon, T., Kropp, B. P., Lakshmanan, Y., Meyer, S., Meyer, T., Mullins, L. L., Mullins, A., Palmer, B., W., Paradis, A., Reddy, P., Scott-Reyes, K. J., Schulte, M., Swartz, J. M., Yerkes, E., Wisniewski, A.,Wolfe-Christensen, C.& Poppas, D. (2017). 12 month surgical outcomes following genitoplasty in children with moderate-to-severe genital atypia. Hormone Research in Paediatrics, 88, 13-14.

Perez, M. N., Bakula, D. M., Sharkey, C. M., Austin, P., Baskin, L., Bernabé, K. J., Cheng, E., Diamond, D., Ellens, R., Fried, A., Galan, D., Gonzalez, L., Greenfield, S., Kolon, T., Kropp, B. P., Lakshmanan, Y., Meyer, S., Meyer, T., Mullins, A. J., Nokoff, N. J., Palmer, B., W., Poppas, D., Paradis, A., Reddy, P., Scott-Reyes, K. J., Wisniewski, A.,Wolfe-Christensen, C., Yerkes, E., & Mullins, L. L. (2017). Social support and financial changes for parents of children born with ambiguous genitalia. Hormone Research in Paediatrics, 88, 559-560.

Sharkey, C. M., Bakula, D. M., Austin, P., Baskin, L., Bernabé, K., Cheng, E., Ellens, R., Fried, A., Frimberger, D., Galan, D., Gonzalez, L., Greenfield, S., Kolon, T., Kropp, B. P., Lakshmanan, Y., Meyer, S., Meyer, T., Mullins, A., Nokoff, N. J., Palmer, B., W., Poppas, D., Paradis, A., Reyes, K., Wisniewski, A.,Wolfe-Christensen, C., Yerkes, E., & Mullins, L. L. (2017). The influence of parent-rated severity of illness on parent anxiety in families with children born with ambiguous genitalia. Hormone Research in Paediatrics, 88, 365.

Paper References

Delozier, A. M., Gamwell, K. L., Sharkey, C., Bakula, D. M., Perez, M. N., Wolfe-Christensen, C., Austin, P., Baskin, L., Bernabe, K. J., Chan, Y., Cheng, E. Y., Diamond, D. A., Ellens, R. E. H., Fried, A., Galan, D., Greenfield, S., Kolon, T., Kropp, B., Lakshmanan, Y., Meyer, S., Meyer, T., Nokoff, N. J., Reyes, K. J., Palmer, B., Poppas, D. P., Paradis, A., Tishelman, A. C., Yerkes, E. B., Chaney, J. M., Wisniewski, A. B., & Mullins, L. L. (2019). Uncertainty and posttraumatic stress: Differences between mothers and fathers of infants with disorders of sex development. Archives of Sexual Behavior, 48(5), 1617-1624.

Finlayson, C., Rosoklija, I., Aston, C. E., Austin, P., Bakula, D., Baskin, L., Chan, Y., Delozier, A. M., Diamond, D. A., Fried, A., Greenfield, S., Kolon, T., Kropp, B., Lakshmanan, Y., Meyer, S., Meyer, T., Nokoff, N., Mullins, L. L., Palmer, B., Perez, M. N., Poppas, D. P., Reddy, P., Reyes, K. J. S., Schulte, M., Sharkey, C. M., Yerkes, E., Wolfe-Christensen, C., Wisniewski, A. B., & Cheng, E. Y. (2019). Baseline characteristics of infants with atypical genital development: Phenotypes, diagnoses, and sex of rearing. Journal of the Endocrine Society, 3(1), 264-272.

Perez, M. N., Delozier, A. M., Aston, C. E., Austin, P., Baskin, L., Chan, Y., Cheng, E. Y., Diamond, D. A., Fried, A., Greenfield, S., Kolon, T., Kropp, B., Lakshmanan, Y., Meyer, S., Meyer, T., Nokoff, N., Palmer, B., Paradis, A., Poppas, D., Scott Reyes, K. J., Swartz, J. M., Tishelman, A., Wisniewski, A. B., Wolfe-Christensen, C., Yerkes, E., & Mullins, L. L. (2019). Predictors of psychosocial distress in parents of young children with disorders of sex development. Journal of Urology, 202(5), 1046-1051.

Bernabe, K. J., Nokoff, N. J., Galan, D., Felsen, D., Aston, C. E., Austin, P., Baskin, L., Chan, Y., Cheng, E. Y., Diamond, D. A., Ellens, R., Fried, A., Greenfield, S., Kolon, T., Kropp, B., Lakshmanan, Y., Meyer, S., Meyer, T., Delozier, A. M., Mullins, L. L., Palmer, B., Paradis, A., Reddy, P., Reyes, K. J. S., Schulte, M., Swartz, J. M., Yerkes, E., Wolfe-Christensen, C., Wisniewski, A. B., & Poppas, D. P. (2018). Preliminary report: Surgical outcomes following genitoplasty in children with moderate to severe genital atypia. Journal of Pediatric Urology, 14(2), 157.e1-157.e8.

Sharkey, C. M., Bakula, D. M., Wolfe-Christensen, C., Austin, P., Baskin, L., Bernabe, K. J., Chan, Y., Cheng, E. Y., Delozier, A. M., Diamond, D. A., Ellens, R. E. H., Fried, A., Galan, D., Greenfield, S., Kolon, T., Kropp, B., Lakshmanan, Y., Meyer, S., Meyer, T., Nokoff, N. J., Scott Reyes, K. J., Palmer, B., Poppas, D. P., Paradis, A., Tishelman, A., Yerkes, E. B., Chaney, J. M., Wisniewski, A. B., & Mullins, L. L. (2018). Parent-rated severity of illness and anxiety among caregivers of children born with a disorder of sex development including ambiguous genitalia. Hormone Research in Paediatrics, 90(5), 308-313.

Suson, K. D., Wolfe-Christensen, C., Elder, J. S., & Lakshmanan, Y. (2018). Differences in early career operative experiences among pediatric urologists. Journal of Pediatric Urology, 14(4), 333.e1-333.e7.

Bakula, D. M., Mullins, A. J., Sharkey, C. M., Wolfe-Christensen, C., Mullins, L. L., & Wisniewski, A. B. (2017). Gender identity outcomes in children with disorders/differences of sex development: Predictive factors. Seminars in Perinatology, 41(4), 214-217.

Bakula, D. M., Sharkey, C. M., Wolfe-Christensen, C., Mullins, A. J., Meyer, J., Mullins, L. L., & Wisniewski, A. B. (2017). Recommendations for the establishment of disorders/differences of sex development interdisciplinary care clinics for youth. Journal of Pediatric Nursing, 37, 79-85.

Ellens, R. E. H., Bakula, D. M., Mullins, A. J., Scott Reyes, K. J., Austin, P., Baskin, L., Bernabe, K., Cheng, E. Y., Fried, A., Frimberger, D., Galan, D., Gonzalez, L., Greenfield, S., Kolon, T., Kropp, B., Lakshmanan, Y., Meyer, S., Meyer, T., Mullins, L. L., Nokoff, N. J., Palmer, B., Poppas, D., Paradis, A., Yerkes, E., Wisniewski, A. B., & Wolfe-Christensen, C. (2017). Psychological adjustment of parents of children born with atypical genitalia 1 year after genitoplasty. Journal of Urology, 198(4), 914-920.

Nokoff, N. J., Palmer, B., Mullins, A. J., Aston, C. E., Austin, P., Baskin, L., Bernabe, K., Chan, Y., Cheng, E. Y., Diamond, D. A., Fried, A., Frimberger, D., Galan, D., Gonzalez, L., Greenfield, S., Kolon, T., Kropp, B., Lakshmanan, Y., Meyer, S., Meyer, T., Mullins, L. L., Paradis, A., Poppas, D., Reddy, P., Schulte, M., Reyes, K. J. S., Swartz, J. M., Wolfe-Christensen, C., Yerkes, E., & Wisniewski, A. B. (2017). Prospective assessment of cosmesis before and after genital surgery. Journal of Pediatric Urology, 13(1), 28.e1-28.e6.

Wolfe-Christensen, C., Wisniewski, A. B., Mullins, A. J., Reyes, K. J., Austin, P., Baskin, L., Bernabe, K., Cheng, E., Fried, A., Frimberger, D., Galan, D., Gonzalez, L., Greenfield, S., Kolon, T., Kropp, B., Lakshmanan, Y., Meyer, S., Meyer, T., Nokoff, N. J., Palmer, B., Poppas, D., Paradis, A., Yerkes, E., & Mullins, L. L. (2017). Changes in levels of parental distress after their child with atypical genitalia undergoes genitoplasty. Journal of Pediatric Urology, 13(1), 32.e1-32.e6.

Suorsa, K. I., Mullins, A. J., Tackett, A. P., Reyes, K. J. S., Austin, P., Baskin, L., Bernabe, K., Cheng, E., Fried, A., Frimberger, D., Galan, D., Gonzalez, L., Greenfield, S., Kropp, B., Meyer, S., Meyer, T., Nokoff, N., Palmer, B., Poppas, D., Paradis, A., Yerkes, E., Wisniewski, A. B., & Mullins, L. L. (2015). Characterizing early psychosocial functioning of parents of children with moderate to severe genital ambiguity due to disorders of sex development. Journal of Urology, 194(6), 1737-1742.

Wolfe-Christensen, C., Fedele, DA, Mullins LL, Lakshmanan Y, & Wisniewski, AB. Differences in anxiety and depression between male and female caregivers of children with a disorder of sex development. J Pediatr Endocrinol Metab. 2014;27:617-621.

Wolfe-Christensen, C., Fedele, D.A., Kirk, K. Mullins, L.L., Lakshmanan, Y., & Wisniewski, A.B. Stress is differentially associated with parenting style and mental health of caregivers of children with a disorder of sex development. J Pediatr Urol. 10:538-543.

Wolfe-Christensen, C., Fedele, D.A., Kirk, K., Mullins, L.L., Lakshmanan, Y. & Wisniewski, A.B. Caregivers of children with a disorder of sex development: Associations between parenting capacities and psychological distress. J Pediatr Urol. 2014;10:538-43. doi: 10.1016/j.jpurol.2013.11.016

Wolfe-Christensen, C., Fedele, D.A., Kirk, K., Phillips, T.M., Mazur, T., Mullins, L.L., Chernausek, SD., Lakshmanan, Y., & Wisniewski, A.B. (2012). Degree of external genital malformation at birth in children with a disorder of sex development and subsequent caregiver distress. J Urol. 2012; 88:1596-1600. doi: 10.1016/j.juro.2012.02.040.

Kirk, K.D., Fedele, D.A., Wolfe-Christensen, C., Phillips, T.M., Mazur, T., Mullins, S.D. et al. (2011). Parenting characteristics of female caregivers of children affected by chronic endocrine conditions: Comparisons between disorders of sex development and type 1 diabetes mellitus. J Pediatr Nurs. 2011;26:29-36. doi: 10.1016/j.pedn.2010.10.005.

Hullmann, S.E., Fedele, D.A., Wolfe-Christensen, C., Mullins, L.L., & Wisniewski, A.B. Differences in adjustment by developmental stage among caregivers of children with disorders of sex development. Int J Pediatr Endocrinol, 2011;16. 
doi: 10.1186/1687-9856-2011-16.

Fedele, D.A., Kirk, K., Wolfe-Christensen, C., Phillips, T., Mazur, T., Mullins, L.L. et al., Primary caregivers of children affected by disorders of sex development (DSD): Mental health and caregiver characteristics in the context of genital ambiguity and genitoplasty. International J Pediatri Endocrinol. 2010; Epub June 13. doi: 10.1155/2010/690674.


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