Treatment with Growth Hormone and Luteinizing Hormone Releasing Hormone Analog Improves Final Adult Height in Children with Congenital Adrenal Hyperplasia

Abstract

Final adult height is often compromised in children with congenital adrenal hyperplasia (CAH). This study examines the impact of GH and LHRH analog (LHRHa) on final adult height in patients with CAH due to 21-hydroxylase deficiency. Fourteen patients with CAH (eight males, six females) predicted to be more than 1.0 sd below their midparental target height received GH and LHRHa until final height. Each patient was matched at the start of GH therapy to a CAH patient treated only with glucocorticoids according to type of CAH, sex, and chronological age. Mean age, bone age, height, height prediction, and target height were the same in both groups at the beginning of GH therapy. Mean duration of GH treatment was 4.4 +/- 1.5 yr. Mean duration of LHRHa therapy was 4.2 +/- 2.0 yr. In the treatment group, final height sd score of -0.4 + 0.8 was significantly greater than both the initial prediction of -1.5 +/- 0.9 (P < 0.0001) and the final height sd score of the untreated group of -1.4 +/- 1.1 (P = 0.01). Our results indicate that the combination of GH and LHRHa improves final adult height in patients with CAH.

Final height in congenital adrenal hyperplasia: the dilemma of hypercortisolism versus hyperandrogenism

“…Recent data point out to the harm ful impact of glucocorticoid treatment in FH outcomes (11), and other reports suggest better outcomes after the use of lower HC doses (12)(13). Alternative treatments, such as the use of growth hormone associated to puberty inhibitors, in addition to anti-estrogen therapy, were used in an attempt to improve height prognosis in these patients (14)(15)(16)(17). However, the high cost, greater likelihood of non-compliance with multi--drug regimens, and the associated side effects, render these alternatives little attractive.…”

Growth and Reproductive Outcomes in Congenital Adrenal Hyperplasia

“…In both groups, growth rate and height prediction improved and there was a reduction in height deficit for bone age after one and two years of therapy [51, 52]. In a nonrandomized study of 14 patients with CAH who received both GH and a GnRH analog, FH and gain in height were statistically better when compared to a similar, untreated group [53]. Mean FH SDS was −0.4 ± 0.8 in the treated group compared to −1.4 ± 1.1 in the untreated group.…”

Limb lengthening in children with Russell–Silver syndrome: A comparison to other etiologies

“…Increased linear growth without concomitant increase in limb length discrepancy was reported in the setting of RSS patients [8][9][10][11]. Various conditions have been indicated for hGH treatment, including congenital short stature, Turner syndrome, Prader-Willi syndrome, Noonan syndrome, chronic renal failure, congenital adrenal hyperplasia, idiopathic small stature, and small for gestational age complex [12][13][14][15][16][17][18][19]. While hGH therapy increases the total limb length, it does not appear to induce limb-specific catch-up growth or reduce the discrepancy between limbs.…”