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Relationship between final height and health outcomes in adults with congenital adrenal hyperplasia: United Kingdom congenital adrenal hyperplasia adult study executive (CaHASE).
[congenital adrenal hyperplasia]
Treatment
of
congenital
adrenal
hyperplasia
(
CAH
)
in
childhood
focuses
on
growth
and
development
and
adult
final
height
(
FH
)
is
a
measure
of
effective
treatment
.
We
hypothesized
that
shorter
adults
will
have
more
severe
underlying
disease
and
worse
health
outcomes
.
This
was
a
cross-sectional
analysis
of
199
adults
with
CAH
.
FH
and
quality
of
life
were
expressed
as
z-scores
adjusted
for
midparental
target
height
or
UK
population
height
.
FH
correlated
inversely
with
age
(
men
,
r
=
-
0
.
38
;
women
,
r
=
-
0
.
26
,
P
<
.
01
)
.
Men
and
women
had
z-scores
adjusted
for
midparental
target
height
of
-
2
and
-
1
,
respectively
,
and
both
groups
had
UK
population
height
z-scores
of
-
1
below
the
UK
population
(
P
<
.
01
)
.
In
women
,
FH
was
shorter
in
non-
salt-wasting
than
salt-wasting
classic
CAH
(
P
<
.
05
)
and
in
moderately
affected
genotype
group
B
women
than
either
more
severely
affected
groups
null
and
A
(
P
<
.
01
)
or
the
mildest
group
C
(
P
<
.
001
)
.
Short
stature
and
a
higher
prevalence
of
hypertension
were
observed
in
classic
CAH
patients
diagnosed
late
(
after
1
y
)
compared
with
those
diagnosed
early
and
in
women
treated
with
glucocorticoid
only
compared
with
those
treated
with
both
glucocorticoids
and
mineralocorticoids
(
P
<
.
05
)
.
FH
did
not
associate
with
insulin
sensitivity
,
lipid
profile
,
adiposity
,
or
quality
of
life
.
Adult
CAH
patients
remain
short
,
although
height
prognosis
has
improved
over
time
.
The
shortest
adults
are
those
diagnosed
late
with
moderate
severity
CAH
and
are
at
increased
risk
of
adult
hypertension
;
we
hypothesize
that
these
patients
are
exposed
in
childhood
to
high
androgens
and
/
or
excessive
glucocorticoids
with
potential
programming
of
hypertension
.
Another
possibility
is
inadequate
mineralocorticoid
treatment
early
in
life
in
the
late
-diagnosed
patient
group
.
Prospective
studies
are
now
required
to
examine
these
hypotheses
.
Diseases
Validation
Diseases presenting
"a higher prevalence of hypertension were observed in classic cah patients diagnosed late"
symptom
congenital adrenal hyperplasia
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