ESPE2022 Poster Category 1 Adrenals and HPA Axis (52 abstracts)
Growth evaluation by applying the QEPS growth model in patients with CAH
Ruta Navardauskaite 1 , Rasa Verkauskiene 1 , Aimon Niklasson 2 , Andreas F.M Nierop 3,4 , Kerstin Albertsson-Wikland 3 & Anton Holmgren 2,5
1Institute of Endocrinology, Lithuanian University of Health Sciences, Kaunas, Lithuania; 2GP-GRC, Department of Pediatrics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; 3Department of Physiology/Endocrinology, Institute of Neuroscience and Physiology, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; 4Muvara bv, Multivariate Analysis of Research Data, Leiderdorp, Netherlands; 5Department of Pediatrics, Halland Hospital, Halmstad, Sweden
Objective: Patients with congenital adrenal hyperplasia (CAH) seldom achieve their target height. Early adrenarche may accelerate bone age maturation and affect adult height. The QEPS-growth-model have been used for developing growth references and investigating healthy/pathological growth, however, not before used in individuals with endocrine disorders. This study aimed to evaluate growth patterns in CAH-patients with the QEPS-model.
Methods: Longitudinal growth-data were collected from 25 CAH-patients (13 girls) at Lithuanian University of Health Sciences Hospital1. The QEPS-model2 was used, and the model’s growth-functions and estimates were compared with the GrowUp1974Gothenburg cohort, used for both Swedish growth reference and when developing the QEPS-growth model.
Results: The CAH-patients were similar with the GrowUp1974cohort in birth characteristics and parental heights, except CAH-patients being longer at birth. The CAH-patients had faster tempo of growth as shown by both shorter E-timescale (E-growth function in QEPS-model representing mainly foetal/infancy growth) and earlier onset of pubertal growth. The specific pubertal height gain was lower in CAH-patients and their adult height was lower than expected from parental heights, details in Table1.
| Variable | Mean CAH girls (n13) | Mean Gothenburg girls (n1165) | P-value | Mean CAH boys (n12) | Mean Gothenburg boys (n1174) | P-value |
| Gestational age (weeks) | 39.08 | 39.78 | 0.221 | 39.42 | 39.68 | 0.258 |
| Birth length (cm) | 51.50 | 49.95 | 0.005 | 53.45 | 50.53 | < 0.001 |
| Birth weight (kg) | 3.238 | 3.410 | 0.096 | 3.659 | 3.515 | 0.164 |
| Mother’s height (cm) | 166.6 | 166.1 | 0.386 | 166.9 | 166.8 | 0.473 |
| Father’s height (cm) | 179.9 | 180.1 | 0.456 | 179.8 | 179.5 | 0. 437 |
| Etimescale1 | 0.89 | 1.01 | < 0.001 | 0.80 | 1.01 | < 0.001 |
| Emax (cm) | 61.26 | 62.85 | <.0.036 | 60.14 | 65.07 | < 0.001 |
| Qmax2 (cm) | 97.50 | 97.59 | 0.484 | 109.50 | 104.05 | 0.010 |
| Age P5%3(years) | 8.60 | 9.87 | < 0.001 | 9.97 | 11.82 | < 0.001 |
| Age at peak height velocity (years) | 10.39 | 11.84 | < 0.001 | 11.92 | 13.69 | < 0.001 |
| Pmax4 (cm) | 8.87 | 12.80 | < 0.001 | 10.86 | 17.38 | < 0.001 |
| Tmax5 (cm) | 158.10 | 167.26 | < 0.001 | 169.43 | 180.53 | < 0.001 |
| 1=Tempo of the exponential (E) growth function. 2=Quadratic growth function from before birth until adult height. 3=Age at 5% (onset) of pubertal growth. 4=Specific pubertal height gain. 5=Calculated total/adult height. | ||||||
Conclusion: The QEPS-model has now for the first time been used and proven to characterize growth patterns in patients with CAH. CAH-patients had distinct different growth patterns when compared with a healthy reference population, including faster tempo of growth during infancy/early childhood and puberty with earlier onset, lower specific pubertal gain, resulting in shorter adult height.
References:
1. Navardauskaitė, R, et. al. Medicina(Kaunas). 2021 Sep 29; 57(10):1035
2. Nierop, AF, et. al. J. Theor. Biol. 2016;406:143-65
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