Department of Paediatrics, Faculty of Medicine, Federal University of Minas Gerais, Horizonte, Brazil.

The influence of 15 or 25 mg/m2 of daily oral hydrocortisone with fludrocortisone 0.1 mg/day on growth and laboratory findings was
evaluated in a prospective randomised crossover trial over 12 months in 26 children with 21-hydroxylase deficiency. Nine non-salt losers
had fludrocortisone stopped for a further six month period. Height velocity was significantly decreased during treatment with 25 mg/m2
as compared with 15 mg/m2. This was the most sensitive indicator of corticosteroid treatment excess. A dose dependent effect upon
plasma concentrations of 17-hydroxyprogesterone, testosterone, and androstenedione was found but increased values were still detected
in more than half of the determinations made during the 25 mg/m2 period. Height velocity and 17-hydroxyprogesterone concentrations
were positively correlated. Growth hormone response to clonidine stimulation and insulin-like growth factor-1 concentrations were both
within reference values and there was no difference between treatment periods. Withdrawal of fludrocortisone did not result in any
difference for the non-salt losers. It was concluded that 25 mg/m2 of hydrocortisone depressed growth in children with congenital
adrenal hyperplasia, and that full suppression, or even normalisation, of plasma concentrations of 17-hydroxyprogesterone and androgens
should not be considered a treatment goal, but instead an indication of corticosteroid treatment excess.

Publication Types:

Clinical Trial
Randomized Controlled Trial

PMID: 9370898 [PubMed - indexed for MEDLINE]

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