SFEBES2009 Poster Presentations Steroids (36 abstracts)
Sexual dichotomy in long term growth trajectories of children with 21-hydroxylase deficiency congenital adrenal hyperplasia (CAH)
Sudha Chandrasekhar 1 , Leena Patel 1,2 , Islay Gemmell 2 , Rakesh Amin 1 , Indi Banerjee 1 , Catherine Hall 1 , Julie Jones 1 , Elaine O’Shea 1 & Peter Clayton 1,2
1Central Manchester & Manchester Children’s University Hospitals, Manchester, UK; 2The University of Manchester, Manchester, UK.
Objective: To evaluate longitudinal growth in 21-hydroxylase deficiency CAH, factors contributing to this and outcome for BMI, weight (Wt) and height (Ht) in adolescence.
Methods: Multi-level longitudinal models were used to evaluate growth patterns of 28 males and 29 females with CAH. Age at adiposity rebound was derived from the roots of the fitted curves and compared to UK 1990 references. The influence of hydrocortisone (HC) and fludrocortisone (FC) doses on the growth models was assessed.
Results: Trends in BMI, Wt and Ht SDS were best fitted by cubic models. BMI and Wt SDS trajectories remained higher than Ht SDS throughout and were fairly synchronous in males but diverged in females.
All three were below 0 in infancy, showed catch up through childhood, reached a plateau in adolescence and declined thereafter. The early catch-up was more dramatic in males than females, and Ht SDS in females remained below 0 throughout. Adiposity rebound occurred 2.6 y and 3.9 y earlier in boys and girls respectively, and at higher BMI than the UK population. BMI SDS remained above 0 after early childhood. Over the 15 years, there was no relationship between HC or FC doses and growth variables.
Thirty-one percent (9M, 9F) patients through childhood and 23% (5/22) at age ≥15 years had BMI ≥+2 SDS. 5% (1M, 2F) patients through childhood and 9% (2/22) at age ≥15 years had Ht below −2 SDS.
Conclusion: The growth patterns we observed appeared to be influenced by age and gender but not corticosteroid treatment. Our patients had a trend to increasing BMI from an early age, greater adiposity during childhood and females had disproportionately greater adiposity but shorter stature during adolescence. There is therefore a predisposition to obesity in later life and weight management advice should be emphasised from early childhood.
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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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