ESPE Abstracts

Introduction: Debate still exists about the safety of long-term use of prednisone (P) versus hydrocortisone (HC) for treating children with congenital adrenal hyperplasia -21OH D (CAH).

Aim: To investigate the linear growth and weigh gain as well as metabolic component in children with CAH who were treated with either HC or P since early infancy for 5 years or more.

Methods: Data of 30 children with CAH was analysed retrospectively. They received P (n= 22) or HC (n= 8) in addition to fludrocortisone for 5 years or more. Those on HC were taking 15.2 +/- 3.7 mg /m2 daily and those on P were taking 21 +/- 5 mg/m2 HC equivalent dose. The growth data and blood pressure (BP) were recorded each clinic visit. Metabolic data included measuring fasting blood glucose, triglycerides, cholesterol, LDL and HDL.

Results: After 5 years of treatment with P or HC the HtSDS, BMI and BP did not differ significantly between the two groups. Six out of the 22 children on P therapy had short stature (HtSDS <-2) while 1 out the 8 children on HC had short stature (Table 1). Fasting glucose, insulin and HOMA-IR vales did not differ between the two groups. However, high cholesterol was detected in 3/22 of those treated with P and low HDL was detected in 1/22 of those treated with P but none of the HC treated group. LDL was significantly higher in the P treated group versus the HC group. Obesity (OB) and overweight (OW) occurred both in the P (32% and 27.3% respectively) and in HC groups (12.5 % and 50% respectively). Hypertension was detected in 1 patient on P and another on HC treatment.

Conclusion: A single daily dose of P was comparable to twice daily HC dose in achieving control of children with CAH. Increased occurrence of overweight and obesity was significant in both groups. There was slightly higher LDL and cholesterol level in the P treated group vs HC treated group.