Randomised controlled trial of growth effect of hydrocortisone in congenital adrenal hyperplasia
a Federal University of
Minas Gerais, Belo Horizonte, Brazil: Unit of Paediatric
Endocrinology, b Department of
Paediatrics, c Department of Medicine, Federal
University of São Paulo, Brazil
Correspondence to: Dr I N Silva, Department of Paediatrics, Faculty of Medicine, Federal University of Minas Gerais, Avenue Alfredo Balena 190, 30130-100 Belo Horizonte, MG, Brazil.
Accepted 5 June 1997
The influence of 15 or 25 mg/m2 of daily oral
hydrocortisone with fludrocortisone 0.1 mg/day on growth and laboratory
findings was evaluated in a prospective randomised crossover trial over 12 months in 26 children with 21-hydroxylase deficiency. Nine non-salt
losers had fludrocortisone stopped for a further six month period.
Height velocity was significantly decreased during treatment with 25 mg/m2 as compared with 15 mg/m2. This was the
most sensitive indicator of corticosteroid treatment excess. A dose
dependent effect upon plasma concentrations of 17-hydroxyprogesterone,
testosterone, and androstenedione was found but increased values
were still detected in more than half of the determinations made during
the 25 mg/m2 period. Height velocity and
17-hydroxyprogesterone concentrations were positively correlated.
Growth hormone response to clonidine stimulation and insulin-like
growth factor-1 concentrations were both within reference values and
there was no difference between treatment periods. Withdrawal of
fludrocortisone did not result in any difference for the non-salt
losers. It was concluded that 25 mg/m2 of hydrocortisone
depressed growth in children with congenital adrenal hyperplasia, and
that full suppression, or even normalisation, of plasma concentrations
of 17-hydroxyprogesterone and androgens should not be considered a
treatment goal, but instead an indication of corticosteroid treatment excess.
© 1997 by Archives of Disease in Childhood
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