Growth Patterns in the First Three Years of Life in Children with Classical Congenital Adrenal Hyperplasia Diagnosed by Newborn Screening and Treated with Low Doses of Hydrocortisone

Background: Linear growth is the best clinical parameter for
monitoring metabolic control in classical congenital adrenal
hyperplasia (CAH). Objective: To analyze growth patterns in
children with CAH diagnosed by newborn screening and treated with
relatively low doses of hydrocortisone during the first year of
life. Patients and Methods: 51 patients (27 females) were diagnosed
with classical CAH by newborn screening. All patients were treated
with relatively low doses of hydrocortisone (9-15 mg/m(2) body
surface area). 47 patients were additionally treated with
fludrocortisone. Results: At birth, height SDS (H-SDS) was 1.1 +/-
1 in girls and 0.9 +/- 1.5 in boys. After 3 months, H-SDS decreased
to 0.4 +/- 0.9 in girls and to 0.1 +/- 1.3 in boys. Over the 3-year
period, H-SDS further decreased to -0.4 +/- 1.8 in girls and to
-0.8 +/- 1 in boys and approached the genetic height potential
(target H-SDS of girls -0.5 +/- 0.3 and target H-SDS of boys -0.9
+/- 0.7). During the first 9 months of age, growth velocity was
slightly decreased in girls (18.2 +/- 1.9 cm) and boys (17.3 +/-
1.6 cm) when compared to a healthy reference population (girls 19.0
+/- 3.9 cm and boys 18.7 +/- 4.7 cm). At the age of 3 years, bone
age was appropriate for chronological age in both girls (2.7 +/-
0.5 years) and boys (2.9 +/- 0.5 years). Conclusion: Birth length
is above average in children with classical CAH, which might be the
result of untreated hyperandrogenism in utero. With relatively low
doses of hydrocortisone treatment, growth velocity decreases
slightly during the first 9 months and H-SDS then approaches the
genetic height potential. Copyright (C) 2010 S. Karger AG, Basel