Hi CK,

Welcome to this forum! To try to answer your questions:

1. Yes, it is possible that your son is being overtreated, but that’s probably not the reason why his height prediction has gone down. To tell if he is being over-treated (or under-treated), you would generally look at his levels of adrenal hormones. The CARES website has a good article on monitoring. This will give you an idea of what numbers doctors often strive for. Go to the CARES website, click on "treatment" at the top, then select "monitoring". http://www.caresfoundation.org/

2. Height prediction will go down if "bone age" advances more quickly than "height age." Conversely, it will go up if "bone age" advances more slowly than "height age."

If your son’s height prediction has gone down in the last two years, it is probably because his bone age has advanced more quickly than the gains he has made in height. This can be because 1) his CAH is still not under good control and he is still producing a lot of excess androgens 2) he is getting excess androgens from another source besides the adrenal glands (such as his testicles) or 3) both 1 and 2. I suspect the reason is probably #2 (and that is why his doctor ordered the Lupron stimulation test), but you should (of course) ask her directly.

Also, I don’t know if it makes you feel any better, but your son’s height prediction can still change. Just because it has gone down, does necessarily mean it cannot go up again. If his bone age remains stable, but he starts to grow better, his height prediction will go up.

3. I am not sure there is any real "consensus" on growth hormones...per se. For use in CAH patients, they are still considered to be experimental and doctors are still trying to compile data comparing final height with or without GH. Given that there is a limited study population and it takes a long time for a child to reach final height, this has been somewhat slow going.

However, Dr. Vogiatzi of Cornell has had some CAH patients on GH reach final height (about 12-14?). Her results generally support the notion that, when a child is also on Lupron, GH appears to increase final height. These results are consistent with some trials of GH in children with precocious puberty, also on Lupron, but who do NOT have CAH.

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In my opinion:

I think it is important to note that GH is not going to make anyone taller than they were genetically meant to be. However, in situations where a child might have problems attaining his genetic height potential because of a medical condition, or because of treatment for a medical condition, GH might help to level the playing field a bit.

Anyway, sorry to blab on and hope this helps.