ESPE Abstracts

Introduction: Adult height in individuals with Congenital Adrenal Hyperplasia (CAH) is reduced compared to the general population as their growth during childhood can be negatively impacted by both the disease and its treatment. Excess production of androgens through aromatization to estrogens can accelerate height velocity and skeletal maturity, and lead to short stature if not adequately suppressed. Over suppression of adrenal steroids through excess glucocorticoid therapy can impede linear growth. Since the growth pattern of children with CAH differs from the general population, normative data for growing CAH children can help guide treatment decisions and evaluate the effectiveness of new treatments in clinical trials.

Objective: To develop CAH specific reference growth charts for children ages 6 month through 20 years.

Methods: Data for this study came from a single institution between 1970 and 2021. Height and weight data were obtained from clinical records of 210 (124 female) children with CAH from birth through 20 years. Growth data from 5289 clinic visits (3115 females) were used. The Lambda-Mu-Sigma growth modeling technique was used to estimate Height-for-age, weight-for-age, and BMI-for-age reference percentile ranges for CAH children. Derived percentiles were then compared to the WHO growth standard for patients <2 years and the CDC 2000 reference chart for US children for those ages 2-20 years.

Results: Relative to the WHO and CDC charts, height-for-age and BMI-for-age percentiles of CAH patients varied dramatically over the entire growth period. Weight-for-age tracked closely with the normative growth only for the first 2years of life in both males and female but were higher after 4 years. Median height-for-age percentiles in CAH males and females were higher than the normative reference beginning at 3 years, lack a pubertal growth spurt and fall below the reference population at an age when children without CAH typically have achieved most of their pubertal growth. Median BMI-for-age percentiles in CAH children were higher than the normative reference beginning at 10 (female) and 14 months (male).

Conclusion: Growth patterns of CAH patients follow vastly different trajectories relative to available normative charts. CAH growth charts are needed by parents and clinicians to monitor the growth of CAH children in response to currently available treatment and provide historical reference data to guide the interpretation of new treatment paradigms.