Most of the information I have read indicates that the best case senerio is to be about 2cm lower than projected height.  I have read in various places that increased hormonal activety affects the metabolism of hydrocortisone.  This happens in teenage kids and women on the pill.  I am sure the research will be more conclusive in relation to management practice but it is something that needs to be kept in mind

Many of you know that my son has CAhypoplasia but the height issue has shown no significant difference between the final height of CAhyperplasia and Hypoplasia kids.  A few sentence in a paper titled 'Dhea and the Skeleton' caught my eye.  Between the ages of 6 and 8yr, serum levels of Dhea(s) and other androgens begin to rise.  With the onset of puberty and activation of the hypothalmic-pituitary- gonadal axis, serum levels increase sharply to acheive peak levels during the early twenties. Whereas serum Dhea levels rise with the advancement of chronological and skeletal age, cortisol and ACTH levels remain relatively costant..  Beginning with  young adulthood, levels of DHEA decline and are between 10 and 20 % of young adult levels by 70.  The study shows that Dhea has a vital role within the skeletal IGF(insulin growth factor system) which plays an important role in the maintainance of bone density.

We come at Dhea from opposite ends with controlling Dhea and androgen production in   Cahyperplasia an issue to no production of Dhea or androgens at all in Cahypoplasia kids.

From my reading of the statement above the lack of Dhea in the system will have negative effects on bone density and skeletal development which would account for the loose of height in CAHypoplasia kids.  The over management of androgen and Dhea production would have the same results of reduced final height for Cahyperplasia kids. 

I cannot remember any specific posts but my feeling from the board over the last year is that Dhea is seen as the enemy within the management of CAHyperplasia.  All my research has indicated the opposite in that it is vital for skeletal development, is important for coping with stress, anxiety and improves general well-being as well as being an important factor in the immune system.  It has been shown that Dhea excretion follows the same pattern as hydrocortisone on the circadian rythmn and that the body increases production as it does for hydrocortisone in the intial stages of an infection and then cuts back.

I did not participate in the osteoperosis threads further down the page because I only have just reviewed the Dhea material for an paper I just wrote as part of an interview, but I hope some of you will have a view or two on the above, if you can make sense of my writting.

ShaunP.

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