A Retrospective Analysis of the Growth Pattern in Patients with Salt-wasting 21-Hydroxylase Deficiency

The objective of this study was to investigate the growth pattern of children with thesalt-wasting form of congenital adrenal hyperplasia caused by 21-hydroxylase deficiency(21-OHD). We reviewed the medical records of 13 patients in whom salt-wasting 21-OHD wasdiagnosed during the first 2 mo of life at our hospital from 1980 through 2008. Sixreached adult height. Growth patterns, bone age, biochemical data, and the hydrocortisonedose at each growth stage were analyzed retrospectively. The mean adult height was 155.1 ±6.5 cm (mean ± SD) in females and 158.1 ± 7.1 cm in males. Although length at birth wasnormal or longer than the national mean in almost all patients, the mean height SD scoreof both boys and girls decreased to below 0 SD during infancy. Subsequently, both boys andgirls transiently showed growth acceleration and reached their peak growth velocity at3–10 yr of age. In conclusion, in addition to suppression of growth during infancy, therewas inappropriate growth acceleration during childhood. Especially from 3 mo to 3 yr ofage, decreasing the hydrocortisone dose in patients who exhibit slower growth may lead tosatisfactory height outcomes. Also, strict adjustment of the hydrocortisone dose to avoidaccelerated growth from childhood to adolescence might improve adult height outcomes ofpatients with 21-OHD.