Eric M Bomberg1, O Yaw Addo2, Jennifer Kyllo3, Maria T Gonzalez-Bolanos1, Aida M Ltief4, Siobhan Pittock4, John H Himes5, Bradley S Miller1, Kyriakie Sarafoglou6. 1. Department of Pediatrics, University of Minnesota Children's Hospital, Minneapolis, MN. 2. Global Health, Rollins School of Public Health of Emory University, Atlanta, GA. 3. Pediatrics, Children's Hospitals of Minnesota, Minneapolis, MN. 4. The Mayo Clinic College of Medicine, Rochester, MN. 5. Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN. 6. Department of Pediatrics, University of Minnesota Children's Hospital, Minneapolis, MN. Electronic address: saraf010@umn.edu.
Abstract
OBJECTIVES: To determine the relationships between peripubertal and pubertal timing and growth, along with glucocorticoid exposure, to the reduced final adult height seen in patients with congenital adrenal hyperplasia (CAH). STUDY DESIGN: Chart review of 104 children with classic CAH (41 males: 28 salt-wasting, 13 simple-virilizing; 63 females: 38 salt-wasting, 25 simple-virilizing) were selected from a cohort from 3 medical institutions in Minnesota. Triple logistic modeling of longitudinal data was performed to determine patterns of peripubertal and pubertal growth. RESULTS: Hydrocortisone dose was similar between subtypes and during all growth periods. Simple-virilizing boys (P < .01) and girls (P < .01) were diagnosed later than their salt-wasting counterparts. Height at take-off SDS was reduced for patients with salt-wasting (boys: P < .01; girls: P < .01), and bone age at take-off SDS was more advanced for patients with simple-virilizing (boys: P < .01; girls: P = .05). Bone age at pubertal onset SDS was advanced for all patients, but more so for boys and girls with simple-virilizing. Although all patients had reduced final adult height SDS, this was more pronounced in patients with salt-wasting. CONCLUSION: Reduced final adult height SDS in patients with salt-wasting vs simple-virilizing may be attributable in part to a later age of diagnosis and resultant less prolonged exposure to hydrocortisone. This finding suggests that duration of hydrocortisone treatment in the peripubertal period, independent of the hydrocortisone dose, may affect final adult height in patients with CAH.
OBJECTIVES: To determine the relationships between peripubertal and pubertal timing and growth, along with glucocorticoid exposure, to the reduced final adult height seen in patients with congenital adrenal hyperplasia (CAH). STUDY DESIGN: Chart review of 104 children with classic CAH (41 males: 28 salt-wasting, 13 simple-virilizing; 63 females: 38 salt-wasting, 25 simple-virilizing) were selected from a cohort from 3 medical institutions in Minnesota. Triple logistic modeling of longitudinal data was performed to determine patterns of peripubertal and pubertal growth. RESULTS:Hydrocortisone dose was similar between subtypes and during all growth periods. Simple-virilizing boys (P < .01) and girls (P < .01) were diagnosed later than their salt-wasting counterparts. Height at take-off SDS was reduced for patients with salt-wasting (boys: P < .01; girls: P < .01), and bone age at take-off SDS was more advanced for patients with simple-virilizing (boys: P < .01; girls: P = .05). Bone age at pubertal onset SDS was advanced for all patients, but more so for boys and girls with simple-virilizing. Although all patients had reduced final adult height SDS, this was more pronounced in patients with salt-wasting. CONCLUSION: Reduced final adult height SDS in patients with salt-wasting vs simple-virilizing may be attributable in part to a later age of diagnosis and resultant less prolonged exposure to hydrocortisone. This finding suggests that duration of hydrocortisone treatment in the peripubertal period, independent of the hydrocortisone dose, may affect final adult height in patients with CAH.
Authors: Kyriakie Sarafoglou; Gregory P Forlenza; O Yaw Addo; Jennifer Kyllo; Aida Lteif; P C Hindmarsh; Anna Petryk; Maria Teresa Gonzalez-Bolanos; Bradley S Miller; William Thomas Journal: Clin Endocrinol (Oxf) Date: 2017-03-28 Impact factor: 3.478
Authors: Mahmoud Al-Kofahi; Mariam A Ahmed; Mutaz M Jaber; Thang N Tran; Brian A Willis; Cheryl L Zimmerman; Maria T Gonzalez-Bolanos; Richard C Brundage; Kyriakie Sarafoglou Journal: Br J Clin Pharmacol Date: 2020-07-26 Impact factor: 3.716