Growth and Final Adult Height Outcomes in Pediatric Patients with Salt-Wasting Congenital Adrenal Hyperplasia

Noor Hamed; Ashraf Soliman; Nada Alaaraj; Shayma Ahmed; Fawzia Alyafei

Introduction: Understanding the growth outcomes and management strategies in Salt-Wasting Congenital Adrenal Hyperplasia (SW-CAH) is crucial for optimizing patient care.

Objective: We review and synthesize the evidence on growth patterns and final adult height outcomes in pediatric patients with SW-CAH, focusing on the effects of different management strategies including glucocorticoid treatment, growth hormone (GH) therapy, and early hydrocortisone dose adjustments.

Methods: A systematic review of literature from 2000 to 2022 (16 studies) were studied and analyzed.

Results: (Table)


Author(s):	Year:	Key Findings:
Cabrera, Vogiatzi, New:	2001	Adult males with CAH due to 21-hydroxylase deficiency exhibit short stature. Fertility issues noted in the salt-wasting form.
Dixon et al:	2017	Adult height in CAH patients in Northern Ireland was -1.5 SDS below mean for both genders.
Lemos-Marini et al:	2005	Final height in CAH patients was below target height, with no significant difference by CAH form or treatment onset age.
Kawano et al:	2014	Early hydrocortisone dose adjustments based on growth velocity could lead to satisfactory height outcomes.
Mohammad et al:	2019	Significant stunting in CAH cases, with salt-losing patients having lower height and higher BMI.
Bomberg et al:	2015	Reduced final adult height SDS in CAH patients, especially in salt-wasting forms.
Han et al:	2014	Adult CAH patients remain short; late-diagnosed, moderate severity CAH at risk of adult hypertension.
Bonfig et al:	2007	Reduced final height in CAH patients treated with prednisone.
Al Shaikh et al:	2019	Final height outcome in CAH patients treated with glucocorticoids is lower than the population norm.
Bonfig:	2016	Treated SV and SW CAH children exhibit reduced final height.
Lin-Su et al:	2005	GH and LHRHa treatment improve final adult height in CAH patients.
Badawi et al:	2021	Bayley-Pinneau method overestimates final adult height in poorly controlled CAH patients.
Mendes-dos-Santos et al:	2011	Growth recovery in CAH patients with mean height similar to general population but with higher body fat.
Costa et al:	2022	Improvement in final height in CAH patients treated with recombinant GH.
Abulgassem, BenRajab:	2022	Showed GH treatment effects on growth.
Lin-Su et al:	2011	GH treatment improves final adult height in CAH patients.

Conclusion: Pediatric patients with SW-CAH face significant challenges in achieving normal growth and final adult height. Management strategies including early and adjusted hydrocortisone dosing, along with adjunct therapies such as GH and LHRHa, have shown promise in improving growth outcomes.

ESPE Abstracts

P3-1