Clinical review: Adult height in patients with congenital adrenal hyperplasia: a systematic review and metaanalysis.
BACKGROUND
Treatment for patients with congenital adrenal hyperplasia (CAH) may affect the final height of these patients.


OBJECTIVE
Our objective was to determine the distribution of achieved height in patients with classic CAH diagnosed at infancy or early childhood and treated with glucocorticoids.


METHODS
We searched MEDLINE, EMBASE, Cochrane Library, ISI Web of Science, and Scopus through September 2008; the reference sections of included studies; and expert files.


METHODS
Eligible studies included patients diagnosed with CAH before age 5 and followed to final height.


METHODS
Reviewers working in duplicate independently extracted data on study characteristics and outcomes and determined each study's risk of bias.


RESULTS
The sd score (SDS) for final height and corrected height (defined as final height SDS - midparental height SDS) were estimated from each study and pooled using random-effects metaanalysis. The I(2) statistic was used to assess inconsistency in results across studies.


RESULTS
We found 35 eligible studies, most of which were retrospective single-cohort studies. The final height SDS achieved by CAH patients was -1.38 (-1.56 to -1.20; I(2) = 90.2%), and the corrected height SDS was -1.03 (-1.20 to -0.86; I(2) = 63.1%). This was not significantly associated with age at diagnosis, gender, type and dose of steroid, and age of onset of puberty. Mineralocorticoid users had a better height outcome in comparison with the nonusers (P = 0.02).


CONCLUSIONS
Evidence derived from observational studies suggests that the final height of CAH patients treated with glucocorticoids is lower than the population norm and is lower than expected given parental height.
Muthusamy
Kalpana
K
Knowledge and Encounter Research Unit, Mayo Clinic, Rochester, Minnesota 55905, USA.
Elamin
Mohamed B
MB
Smushkin
Galina
G
Murad
Mohammad Hassan
MH
Lampropulos
Julianna F
JF
Elamin
Khalid B
KB
Abu Elnour
Nisrin O
NO
Gallegos-Orozco
Juan F
JF
Fatourechi
Mitra M
MM
Agrwal
Neera
N
Lane
Melanie A
MA
Albuquerque
Felipe N
FN
Erwin
Patricia J
PJ
Montori
Victor M
VM
D000312:Adrenal Hyperplasia, Congenital / Q000150:complications / Q000503:physiopathology*; D000328:Adult; D000465:Algorithms; D001827:Body Height / Q000502:physiology; D005938:Glucocorticoids / Q000627:therapeutic use; D006130:Growth Disorders / Q000150:complications / Q000628:therapy; D019382:Human Growth Hormone / Q000627:therapeutic use; D006801:Humans; D008901:Mineralocorticoids / Q000627:therapeutic use; D016896:Treatment Outcome
D005938:Glucocorticoids; D008901:Mineralocorticoids; D019382:Human Growth Hormone