Congenital Adrenal Hyperplasia Clinical Trial
Official title:
Linear Growth of Children With Congenital Adrenal Hyperplasia.
The congenital adrenal hyperplasias (CAHs) comprise a family of autosomal recessive disorders that disrupt adrenal steroidogenesis. Three specific enzyme deficiencies are associated with virilization of affected women. The most common form is 21-hydroxylase deficiency (21-OHD) due to mutations in the 21-hydroxylase (CYP21A2) gene. Other virilizing forms include 3b-hydroxysteroid dehydrogenase type 2 (HSD3B2) and 11b-hydroxylase deficiencies associated with mutations in the HSD3B2 and 11b-hydroxylase (CYP11B1) genes, respectively.
It has been reported that approximately one child in every 18000 born in Great Britain has
CAH. In North America, the incidence varies from 1:15000 to 1:16000. The reported rates of
CAH have been as high as 1:280 among the Yupik people of Alaska and 1:2100 on the French
island of Réunion in Indian ocean; both of these populations are geographically isolated. The
reported incidence of CAH in the two Brazilian states that have routinely included CAH in
their public newborn screening programs is 1:11655 in the South (Santa Catarina) and 1:10325
in Midwest (Goiás).
Salt-losing CAH accounts for about three quartes of cases reported and non-salt losing CAH
for one quarter. Non-classic is more common ;Estimated as 1 in 1000-2000 in white
populations. It is more frequent in certain ethnic groups, such as the Ashkenazi Jewish
population. The mild non-classic form is a common cause of hyperandrogenism.
Treatment of classic 21-OHD consists of replacement doses of gluco- (GC) and
mineralocorticoids aiming to reduce excess androgen, and to allow adequate linear growth.
However, several series report that growth in these children is below expectation, as
compared with both the reference population and the target height (TH).
The reasons for the inadequate growth and impairment of the final height (FH) are not
completely understood. A major cause is the difficulty in accomplishing a fine balance
between inhibition of excess androgen production which accelerates bone maturation and
adequate GC replacement itself which even at slightly supraphysiologic doses can be
deleterious to growth.
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