Final Adult Height in Children With Congenital Adrenal Hyperplasia Treated With Growth Hormone EDITORIAL COMMENT

The final height of patients with congenital adrenal hyperplasia (CAH) due to 21-hydroxylase deficiency is generally below the mid-parental target height. The luteinizing hormone-releasing hormone analog (LHRHa) has been effective in suppressing puberty for CAH patients who develop central precocious puberty. Several studies have shown that the combination of growth hormone (GH) and LHRHa can improve height prediction and final height in non-CAH children with central precocious puberty. In the previous study, GH treatment improved predicted height in CAH patients, and combined treatment with GH and LHRHa improved final adult height in these patients. The aim of this nonrandomized prospective pilot study was to investigate whether GH alone or combined with LHRHa could improve the final adult height in patients with CAH. The treatment group was composed of 34 patients (19 males and 15 females) with 21-hydroxylase deficiency CAH who were treated with GH until reaching final adult height. Inclusion criteria for study participants were final adult height prediction of at least 2 standard deviations below their mid-parental target height or at least 2 standard deviations below the population mean. A total of 27 patients (16 males and 11 females) received both GH and LHRHa. The mean duration of GH therapy in males and females was similar (5.6 +/- 1.8 years and 4.5 +/- 1.6 years, respectively; P = NS). In both sexes, the mean duration of LHRHa therapy was 3.7 +/- 1.7 years. The primary study end point measures were final adult height, final height discrepancy, and gain in height. Compared with the baseline predicted height, the final adult height achieved by GH treatment was significantly higher in both male and female patients (172.0 +/- 4.8 vs. 162.8 +/- 7.7 cm [P < 0.00001] and 162.2 +/- 5.3 vs. 151.7 +/- 5.2 cm [P < 0.0000001], respectively). Similar gains in height were achieved by GH treatment in both sexes (9.2 +/- 6.7 cm in male patients and 10.5 +/- 3.7 cm in female patients. There was no significant difference in the mean gain in height between patients treated with GH plus LHRHa (9.2 +/- 5.8 cm) or those treated with GH alone (11.8 +/- 4.0 cm). These findings demonstrate GH alone or combined with LHRHa is an effective therapy for improving final adult height outcome among children with CAH.