Growth Hormone Treatment in Children with Congenital Adrenal Hyperplasia

Abstract

Final adult height is often compromised in children with congenital adrenal hyperplasia (CAH). This report examines the impact of growth hormone (GH) with or without LHRH analogue (LHRHa) on final adult height in patients with CAH due to 21-hydroxylase deficiency. Boys and girls with CAH who had a predicted final height of more than 2 SD below their mid-parental target height or more than 2 SD below the population mean were eligible for treatment with GH. Other inclusion criteria included open epiphyses (bone age <14 years for boys and bone age <13 years for girls) and bone age ≥1 standard deviation above the mean for chronological age. Subjects received GH (starting dose of 0.3 mg/kg/week) until final adult height was reached. Final adult height was defined as growth velocity ≤1.5 cm/year over a 6-month period and bone age ≥15 in girls or ≥17 in boys. Patients with early central puberty were also treated with an LHRHa. The primary outcome variable was final adult height. Secondary outcome variables were gain in height (final height minus initial predicted height) and height discrepancy (final height minus target height). We report the results of 31 GH-treated CAH patients who have reached final adult height. Mean duration of growth hormone treatment was 4.5 years for girls and 4.9 years for boys. Mean duration of LHRHa therapy was 4.2 years. Girls (n = 15) reached a mean final adult height of 162.1 cm, in contrast to a mean initial predicted height of 153.0 cm.