title: Effect of the dose of oral hydrocortisone on growth rate during long-term treatment of children with salt losing congenital adrenal hyperplasia.
abstract: The effect of the dose of oral hydrocortisone on stature growth rate of patients with the salt losing form of congenital adrenal hyperplasia and adequate electrolyte balance was here assessed. Thirty patients (21 girls and 9 boys) were followed longitudinally for 0.52 to 8.64 years, between chronological ages 0.35 and 8.64 years. Nine consecutive periods (Ps) of follow up were defined in order to compare two auxological parameters, height (H) at the end of a follow up P and delta H standard deviation score (SDS). According to growth rate during a particular P, two types of Ps were defined: Ps with delta H SDS > -0.5 (Group 1, satisfactory growth rate) and Ps with delta H SDS = or < -0.5 (Group 2, poor growth rate). A cut off value of 18.5 mg/m2/day of oral hydrocortisone (95% CI upper limit of group 1) was defined to separate acceptable from excessive doses. In P2, mean (+/- SD) H SDS (-1.81 +/- 1.15) was significantly lower than in any of the other Ps (p < 0.001). In P1 and in P2, delta H SDS was negative, but it was positive in P3 and in P4. Hydrocortisone dose in P1 and in P2 was significantly higher than in the rest of the Ps. All patients in P1 and most patients in P2, but not in other Ps, received excessive doses. Predicted adult H, calculated in 9 patients was not statistically different from their respective target H. It is concluded that, during the first year of life, our patients received an excess of oral hydrocortisone (> 18 mg/m2/day) and grew poorly, but they were able to recover, at least temporarily, when the dose was adjusted during the following years.
authors.affiliation: Servicio de Endocrinología, Hospital de Pediatría Garrahan, Combate de los Pozos 1881, 1245 Buenos Aires, Argentina.
authors.forename: Marta
authors.initials: M
authors.lastname: Ciaccio
authors.forename: Carolina
authors.initials: C
authors.lastname: Montiveros
authors.forename: Marco A
authors.initials: MA
authors.lastname: Rivarola
authors.forename: Alicia
authors.initials: A
authors.lastname: Belgorosky
mesh_terms: D000284:Administration, Oral; D000312:Adrenal Hyperplasia, Congenital / Q000188:drug therapy* / Q000378:metabolism; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage / Q000494:pharmacology*; D001827:Body Height / Q000187:drug effects*; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006854:Hydrocortisone / Q000008:administration & dosage / Q000494:pharmacology*; D007223:Infant; D008137:Longitudinal Studies; D008297:Male; D012189:Retrospective Studies; D012965:Sodium Chloride / Q000378:metabolism*; D013997:Time Factors
chemical_list: D000893:Anti-Inflammatory Agents; D012965:Sodium Chloride; D006854:Hydrocortisone