Ritmo de crescimento de crianças com hiperplasia congênita da supra-renal em tratamento com baixas doses de hidrocortisona

Abstract

We evaluated linear growth of 27 children with congenital adrenal hyperplasia (CAH) treated with low doses of oral hydrocortisone. They were followed-up during 6.1 +/- 1.8 years with daily hydrocortisone doses of 10.84 +/- 2.0 mg/m2 and 0.1 mg fludrocortisone (24 of them). Twenty-three were female. Mean chronological age (CA) was 6.1 +/- 2.9 years and bone age (BA) 6.9 +/- 3.3 (r = 0.66) at the beginning of the study. Five children showed BA advancement > 2 years relating to CA. It was calculated Height SD for CA (SD/H) and for BA (SD/BA) were calculated using NCHS as reference pattern. At the beginning of the study SD/H was -0.8 +/- 1.9 and corresponding SD/BA was -1.5 +/- 2.1; at the end SD/H was -0.17 +/- 1.5 and SD/BA was -1.34 +/- 1.2 (p = 0.02 and p = 0.51, respectively for the beginning and the end). BA changed 1.3 +/- 0.3 per year during this period. Children with advanced BA showed an improvement of SD/BA, from -4.55 +/- 0.9 at from the beginning, -4.55 +/- 0.9 to -2.48 +/- 0.4 at the end of follow-up, -2.48 +/- 0.4 (p = 0.003). The elevated plasma levels of 17-OH Progesterone (17OHP) and androstenedione showed further increase during follow-up. We conclude that children with CAH receiving low doses of hydrocortisone showed adequate growth during the follow-up, without excessive BA advancement, even though full suppression of plasma levels of 17OHP and androgens wasere not achieved.