title: Experience with long-term glucocorticoid treatment in congenital adrenal hyperplasia: growth pattern compared with genetic height potential.
abstract: OBJECTIVE
  Long-term replacement treatment with high doses of steroids in congenital adrenal hyperplasia (CAH) is known to have a negative influence on growth. We evaluated the effects of long-term steroid treatment in patients with classical CAH on height development in relation to genetic height potential.
  
  
  METHODS
  Twenty-three patients with CAH (16 females, 7 males, mean age: 9.8 +/- 3.5 years) were included in this longitudinal study. The effect of steroid treatment on growth was determined by monitoring patients for 8.61 +/- 3.46 years (2-17 years) while they were treated with hydrocortisone at a mean dosage of 17.64 +/- 3.60 mg/m2/day. The height standard deviation scores (Ht-SDS), target Ht-SDS, and corrected Ht-SDS for target height was calculated for all patients. Predicted adult height according to bone age was calculated and it was determined whether height was developing according to the genetic height potential. In addition, patients were grouped as 'tight control' or 'poor control' according to their mean serum 17OH-progesterone or ACTH levels while on treatment. We evaluated whether height development was different for the tight and poor control groups.
  
  
  RESULTS
  The mean chronological age of our patients at the time of the study was 9.89 +/- 3.53 years, Ht-SDS -0.77 +/- 1.57, target height (TH) 161.03 +/- 6.54 cm, TH-SDS -0.60 +/- 0.90, predicted height (PH) 157.2 +/- 11.16 cm, PH-SDS -1.1 +/- 1.69, and corrected Ht-SDS -0.75 +/- 1.14. There was no significant difference between the actual Ht-SDS and TH-SDS of our patients (p >0.05) but the corrected Ht-SDS was less than zero. Only 28.5% of our patients had normal height according to their genetic potential while 71.5% were shorter than their genetic height potential. While the Ht-SDS and corrected Ht-SDS were similar in the tight and poor metabolic control groups, the predicted height was significantly greater in the tight control group.
  
  
  CONCLUSIONS
  We demonstrated that a hydrocortisone dose of 17.64 +/- 3.60 mg/m2/day in classical CAH had a negative influence on height development for genetic height potential in 8.5 years of follow-up and that it is necessary to use the lowest possible steroid dosage by individualizing the dose.
authors.affiliation: Department of Pediatric Endocrinology, Ankara Dişkapi Children's Hospital, Turkey. zehraaycan67@hotmail.com
authors.forename: Zehra
authors.initials: Z
authors.lastname: Aycan
authors.forename: Gonul
authors.initials: G
authors.lastname: Ocal
authors.forename: Merih
authors.initials: M
authors.lastname: Berberoglu
authors.forename: Ergun
authors.initials: E
authors.lastname: Cetinkaya
authors.forename: Pelin
authors.initials: P
authors.lastname: Adiyaman
authors.forename: Olcay
authors.initials: O
authors.lastname: Evliyaoglu
mesh_terms: D019326:17-alpha-Hydroxyprogesterone / Q000097:blood; D000312:Adrenal Hyperplasia, Congenital / Q000097:blood / Q000150:complications / Q000188:drug therapy*; D000324:Adrenocorticotropic Hormone / Q000097:blood; D000365:Age Determination by Skeleton; D000886:Anthropometry; D001827:Body Height / Q000187:drug effects* / Q000235:genetics; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006130:Growth Disorders / Q000097:blood / Q000139:chemically induced* / Q000503:physiopathology*; D020249:Hormone Replacement Therapy / Q000009:adverse effects; D006801:Humans; D006854:Hydrocortisone / Q000009:adverse effects* / Q000627:therapeutic use; D007223:Infant; D008137:Longitudinal Studies; D008297:Male; D018709:Statistics, Nonparametric
chemical_list: D019326:17-alpha-Hydroxyprogesterone; D000324:Adrenocorticotropic Hormone; D006854:Hydrocortisone