Effect on Final Height of Gonadotropin-Releasing Hormone Agonist (GnRHa) in Children with Congenital Adrenal Hyperplasia

Yi, Kyung Hee

Abstract

PURPOSE
Object of present study is to identify the effect of gonadotropin-releasing hormone agonis (GnRHa) treatment on final adult height in congenital adrenal hyperplasia (CAH) children with central precocious puberty. METHOD: A retrospective study was conducted of all CAH patients seen between 1977 and 2004, in pediatric endocrinology department, Seoul National University Hospital. All patients treated with glucocorticoid and mineralocorticoid toward to CAH. Treatment group (SW7, SV12) received GnRHa or associated with growth hormone (GH) when they had pubertal changes; breast development before 8 years in girls, testis enlargement (>4 mL) before 9 years in boys and pubertal response in GnRH stimulation test. GnRHa treatment was continued from 1 year to 7.5 years (mean=3.6 yr) while they continued glucocorticoid therapy. We evaluated them every 6 month or yearly until reached final adult height (FH). We compared FH SDS between treatment group and control group. Also final adult height in treatment group compared with pretreatment predicted adult height (By Bayley-Pinneau method). Each group was subdivided into salt wasting group (SW) and simple virilizing group (SV).
RESULTS
Treatment group (SW 7, SV 12) was included 19 patients with CAH and control group (SW 6 SV 7) was belonged 13 patients. In treatment group, predicted adult heights are 148.5+/-8.8 cm (-2.8+/-0.8SDS) in SW, 149.8+/-6.7 cm (-2.8+/-1.1SDS) in SV and midparental heights are 165.9 7.7 cm (0.4+/-0.5SDS), 163.3+/-p9.0 cm (-1.40+/-0.8SDS), respectively. Final adult heights are 158.87.4 cm(-0.9+/-1.2SDS) in SW and 156.7+/-7.4 cm (-1.5+/-1.2SDS) in SV. In control group, pretreatment predicted adult height and midparental heights were 154.8+/-12.0 cm (-2.1+/-0.6SDS) in SW, 149.9+/-6.3 cm (-2.3+/-0.7SDS) in SV and 159.8+/-7.2 cm (-1.2+/-0.5SDS) in SW, 158.6+/-5.1 cm (-0.6+/-0.8SDS) in SV. Final heights are 154.4+/-5.3 cm (-2.1+/-0.6SDS) in SW and 153.6+/-4.1 cm (-1.5+/-0.8SDS) in SV. There was no significant difference in comparison of FH between control group and treatment group (By Mann-Whitney test, SW P=0.063, SV P=0.663). But it was significant in comparison predicted adult height and final adult height in treatment group (By Wilcoxon Signed Ranks test P=0.043 in SW, P=0.008 in SV).
CONCLUSION
In CAH children with precocious puberty, treatment with GnRH agonist alone treatment is effective to improve final adult height. But the effectiveness is limited. So GH or GnRHa combined with GH therapy is more attempted.