Near-final height in patients with congenital adrenal hyperplasia treated with combined therapy using GH and GnRHa.
BACKGROUND
Intrinsic limitations of glucocorticoid therapy in patients with congenital adrenal hyperplasia (CAH) determine frequent loss in final height. The association of secondary central precocious puberty and early epiphyseal fusion is also frequent. In these conditions, GnRHa treatment alone or in combination with GH has been indicated.


OBJECTIVE
This is a retrospective study, describing the estatural findings of CAH patients with significant decrease in height prediction, who were submitted to combined GH plus GnRHa therapy up to near-final height.


METHODS
We studied 13 patients, eight females and five males, eight with the classical and five with the nonclassical form of the disorder. Treatment with hydrocortisone (10-20 mg/m(2)/day) or prednisolone (3-6 mg/kg/day) was associated with GnRHa (3.75 mg/months) for 4.0 (1.5) years, and GH (0.05 mg/kg/day) for 3.6 (1.4) years.


RESULTS
Stature standard deviation score for bone age improved significantly after GH treatment, becoming similar to target height at the end of the second year of GH treatment.


CONCLUSIONS
We conclude that combined GH plus GnRHa therapy can be useful in a subset of CAH patients with significant reduction of predicted final height associated with poor hormonal control and central precocious puberty.
Pediatric Endocrinology Unit, Pediatric Department, Irmandade da Santa Casa de Misericórdia de São Paulo, Brazil. carloslongui@msn.com
Carlos Alberto
CA
Longui
Cristiane
C
Kochi
Luís Eduardo Procópio
LE
Calliari
Maria Barcellos Rosa
MB
Modkovski
Marisa
M
Soares
Erica Ferreira
EF
Alves
Fernanda Vilas Boas
FV
Prudente
Osmar
O
Monte
D000312:Adrenal Hyperplasia, Congenital / Q000188:drug therapy* / Q000503:physiopathology; D000365:Age Determination by Skeleton; D000704:Analysis of Variance; D001827:Body Height / Q000187:drug effects*; D002648:Child; D002675:Child, Preschool; D004359:Drug Therapy, Combination / Q000379:methods; D005260:Female; D005938:Glucocorticoids / Q000627:therapeutic use*; D007987:Gonadotropin-Releasing Hormone / Q000627:therapeutic use*; D019382:Human Growth Hormone / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D011629:Puberty, Precocious / Q000188:drug therapy / Q000503:physiopathology; D012189:Retrospective Studies; D016896:Treatment Outcome
D005938:Glucocorticoids; D019382:Human Growth Hormone; D007987:Gonadotropin-Releasing Hormone