Randomised controlled trial of growth effect of hydrocortisone in congenital adrenal hyperplasia.
The influence of 15 or 25 mg/m2 of daily oral hydrocortisone with fludrocortisone 0.1 mg/day on growth and laboratory findings was evaluated in a prospective randomised crossover trial over 12 months in 26 children with 21-hydroxylase deficiency. Nine non-salt losers had fludrocortisone stopped for a further six month period. Height velocity was significantly decreased during treatment with 25 mg/m2 as compared with 15 mg/m2. This was the most sensitive indicator of corticosteroid treatment excess. A dose dependent effect upon plasma concentrations of 17-hydroxyprogesterone, testosterone, and androstenedione was found but increased values were still detected in more than half of the determinations made during the 25 mg/m2 period. Height velocity and 17-hydroxyprogesterone concentrations were positively correlated. Growth hormone response to clonidine stimulation and insulin-like growth factor-1 concentrations were both within reference values and there was no difference between treatment periods. Withdrawal of fludrocortisone did not result in any difference for the non-salt losers. It was concluded that 25 mg/m2 of hydrocortisone depressed growth in children with congenital adrenal hyperplasia, and that full suppression, or even normalisation, of plasma concentrations of 17-hydroxyprogesterone and androgens should not be considered a treatment goal, but instead an indication of corticosteroid treatment excess.
Silva
I N
IN
Department of Paediatrics, Faculty of Medicine, Federal University of Minas Gerais, Horizonte, Brazil.
Kater
C E
CE
Cunha
C F
CF
Viana
M B
MB
D019326:17-alpha-Hydroxyprogesterone / Q000097:blood; D000293:Adolescent; D000312:Adrenal Hyperplasia, Congenital / Q000188:drug therapy*; D000735:Androstenedione / Q000097:blood; D001827:Body Height / Q000187:drug effects; D002648:Child; D002675:Child, Preschool; D018592:Cross-Over Studies; D004305:Dose-Response Relationship, Drug; D005260:Female; D006130:Growth Disorders / Q000097:blood / Q000139:chemically induced*; D006801:Humans; D006854:Hydrocortisone / Q000009:adverse effects* / Q000627:therapeutic use; D007223:Infant; D008297:Male; D006899:Mixed Function Oxygenases / Q000172:deficiency; D011446:Prospective Studies; D013739:Testosterone / Q000097:blood
D013739:Testosterone; D000735:Androstenedione; D019326:17-alpha-Hydroxyprogesterone; D006899:Mixed Function Oxygenases; D006854:Hydrocortisone