Hydrocortisone therapy and growth trajectory in children with classical congenital adrenal hyperplasia

Carla Bizzarri, Nicola Improda, Chiara Maggioli, Donatella Capalbo, Silvia Roma, Ottavia Porzio, Mariacarolina Salerno, Marco Cappa

Research output: Contribution to journalArticlepeer-review

Abstract

Objective: Poor linear growth is one of the main concerns in children with congenital adrenal hyperplasia (CAH). We aimed to analyze factors affecting growth trajectory in children with classical CAH. Methods: Clinical records of children followed from infancy up to the end of growth at two Italian tertiary referral hospitals were reviewed. Fifty-seven patients (31 males), treated with hydrocortisone and fludrocortisone only, were included. Clinical observations were divided into three groups: 0 to 2 years, 172 observations; from 2 years to puberty onset, 813 observations; after puberty onset, 527 observations. Height velocity, pubertal growth spurt, and final height were evaluated as outcomes. Results: Final height standard deviation score (SDS) was lower than target height SDS (-0.74 ± 1.1 versus -0.31 ± 1.01; P<.001). Target-adjusted final height SDS was -0.44 ± 1.8 in males and -0.13 ± 1.1 in females (P =.001). Total pubertal growth was 21.9 ± 7.3 cm in males and 19.2 ± 8.2 cm in females (P =.19). Hydrocortisone dose increased and height-velocity SDS decreased during puberty. At multivariable analysis, height-velocity SDS was adversely affected by hydrocortisone dose (P =.038) and directly related to adrenocorticotropic hormone (ACTH) levels (P =.023). Target-adjusted final-height SDS was adversely affected by hydrocortisone dose (P<.001) and positively related to mineralocorticoid therapy (P =.001) and ACTH levels (P =.02). Total pubertal growth (cm) was positively related to ACTH levels (P =.01). Conclusion: Height outcome of CAH patients is now better than previously reported. During puberty, the lowest effective dose of hydrocortisone should be used to optimize pubertal growth spurt and final height.

Original languageEnglish
Pages (from-to)546-556
Number of pages11
JournalEndocrine Practice
Volume23
Issue number5
DOIs
Publication statusPublished - May 1 2017

ASJC Scopus subject areas

  • Endocrinology, Diabetes and Metabolism
  • Endocrinology

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