Growth patterns and final height in congenital adrenal hyperplasia due to classical 21-hydroxylase deficiency - Results of a multicenter study

Background. Longitudinal growth and bone age (BA) development are the most important clinical parameters for monitoring adequate glucocorticoid replac ement in children with congenital adrenal hyperplasia (CAH). Aim of the Stu dy. To analyze the growth pattern of patients treated for CAH of the salt w asting (SW) and simple virilizing (SV) clinical forms; to evaluate final he ight as compared to reference data and individual target height; to evaluat e the course of BA development. Patients and Methods: A large database of 5 98 patients with CAH was created in 5 Central European countries and growth data of 341 treated patients with 21-hydroxylase deficiency were analyzed retrospectively. The patients were of Caucasian origin. Centiles were const ructed in a cross-sectional manner and an additional longitudinal analysis was performed in order to evaluate the pubertal growth spurt by applying pa rticular statistical methods (Preece-Baines model). Results: The growth of SW CAH patients was impaired in infancy and early childhood (0-3 years of a ge), but followed normal patterns in childhood until puberty. In contrast, children with SV CAH had normal patterns of growth in infancy and early chi ldhood and were considerably taller than healthy references during childhoo d. In the longitudinal study, peak height velocity in both boys and girls w as normal, but it occurred at an earlier age than in the standard populatio n. The final height of patients with CAH was reduced in comparison to both the reference and the individual target height. No correlations were found between final height and age at the start of the therapy in SV patients or between final height and year of birth. BA was advanced in both types of CA H, but more accelerated in SV patients. Conclusion: Characteristic growth p atterns for treated SV and SW CAH children were identified, with a normal p ubertal growth spurt and reduced final height being observed. Copyright (C) 2001 S. Karger AG, Basel.