This Article Full Text Full Text (PDF) Submit a related Letter to the Editor Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Copyright Permission Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Stikkelbroeck, N. M. M. L. Articles by van’t Hof, M. A. Search for Related Content PubMed PubMed Citation Articles by Stikkelbroeck, N. M. M. L. Articles by van’t Hof, M. A.

Growth Inhibition by Glucocorticoid Treatment in Salt Wasting 21-Hydroxylase Deficiency: In Early Infancy and (Pre)Puberty

Departments of Pediatric Endocrinology (N.M.M.L.S., B.J.O.), Dental Statistics (B.A.E.v.t.H.-G., M.A.v.t.H.), and Endocrinology (A.R.M.M.H.), University Medical Center Nijmegen, 6500 HB Nijmegen, The Netherlands

Address all correspondence and requests for reprints to: Dr. B. J. Otten, 435 Department of Pediatric Endocrinology, University Medical Center Nijmegen, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands. E-mail address: b.otten{at}cukz.umcn.nl.

In patients with congenital adrenal hyperplasia (CAH) due to 21-hydroxylase deficiency, adult height is below target height. This may result from growth inhibition by glucocorticoid treatment. Previous studies suggest that glucocorticoids have a dose-dependent negative effect on growth in CAH patients and that this effect is age dependent. This study analyzed the correlation between glucocorticoid dose and growth in these patients. A retrospective study was carried out on growth data from 48 patients with classic salt-wasting 21-hydroxylase deficiency who all had been diagnosed in the first year of life and treated from the moment of diagnosis with glucocorticoids and mineralocorticoids. Analysis of the effect of prescribed glucocorticoid dose on growth was performed in age intervals, by analysis of covariance (ANCOVA). The dependent variables height for age z-score (HAZ), weight for age z-score (WAZ) (both corrected for secular trend), and weight for height z-score (WHZ), at 10 selected ages (1, 2, 4, 6, 8, 10, 12, 14, 16, and 18 yr) were explained by 1) mean daily glucocorticoid dose per body surface in the preceding age interval; 2) HAZ, WAZ, or WHZ value at the beginning of the age interval; 3) HAZ, WAZ, or WHZ value 1 yr before the beginning of the considered age interval; and 4) midparental height (only for HAZ). ANCOVA showed that the daily glucocorticoid dose had significant negative effects on HAZ between the ages of 6 and 12 months and between the age of 8–10 and 12–14 yr (and a trend toward significance between 10–12 yr). The negative glucocorticoid effect on HAZ in the age interval of 12–14 yr was as large as in the interval between 6 and 12 months of age. Weight and weight for height were not significantly influenced by glucocorticoid dose in any of the age intervals. We conclude that in CAH patients in the first year of life and between the ages of 8 and 14 yr, there is a dose-dependent negative effect of glucocorticoids on linear growth. Therefore, the daily glucocorticoid dose in these periods should be sufficient to avoid androgen excess, but as low as possible to allow optimal linear growth and adult height.

Abbreviations: ANCOVA, Analysis of covariance; BMI, body mass index; CAH, congenital adrenal hyperplasia; HAZ, height for age z-score; SA, surface area; WAZ, weight for age z-score; WHZ, weight for height z-score.

This article has been cited by other articles:

				W. Bonfig, S. B. Dalla Pozza, H. Schmidt, P. Pagel, D. Knorr, and H. P. Schwarz Hydrocortisone Dosing during Puberty in Patients with Classical Congenital Adrenal Hyperplasia: An Evidence-Based Recommendation J. Clin. Endocrinol. Metab., October 1, 2009; 94(10): 3882 - 3888. [Abstract] [Full Text] [PDF]

				Z. Chakhtoura, A. Bachelot, D. Samara-Boustani, J.-C. Ruiz, B. Donadille, J. Dulon, S. Christin-Maitre, C. Bouvattier, M.-C. Raux-Demay, P. Bouchard, et al. Impact of total cumulative glucocorticoid dose on bone mineral density in patients with 21-hydroxylase deficiency. Eur. J. Endocrinol., June 1, 2008; 158(6): 879 - 887. [Abstract] [Full Text] [PDF]

				W. Bonfig, S. Bechtold, H. Schmidt, D. Knorr, and H. P. Schwarz Reduced Final Height Outcome in Congenital Adrenal Hyperplasia under Prednisone Treatment: Deceleration of Growth Velocity during Puberty J. Clin. Endocrinol. Metab., May 1, 2007; 92(5): 1635 - 1639. [Abstract] [Full Text] [PDF]

				H. L. Claahsen-van der Grinten, K. Noordam, G. F. Borm, and B. J. Otten Absence of Increased Height Velocity in the First Year of Life in Untreated Children with Simple Virilizing Congenital Adrenal Hyperplasia J. Clin. Endocrinol. Metab., April 1, 2006; 91(4): 1205 - 1209. [Abstract] [Full Text] [PDF]

				M. G. Forest Recent advances in the diagnosis and management of congenital adrenal hyperplasia due to 21-hydroxylase deficiency Hum. Reprod. Update, November 1, 2004; 10(6): 469 - 485. [Abstract] [Full Text] [PDF]