Low-Dose Dexamethasone Therapy from Infancy of Virilizing Congenital Adrenal Hyperplasia

Abstract

<p/> <p><it>Objective</it>. To assess the growth and control of adrenal androgen secretion in children with virilizing congenital adrenal hyperplasia (CAH) treated with dexamethasone. <it>Method</it>. We examined doses used, control of adrenal androgen secretion, and growth and skeletal maturation of 8 children with CAH treated with dexamethasone beginning in infancy. <it>Results</it>. 3 boys and 5 girls with classical CAH (17-hydroxyprogesterone at diagnosis >20,000 ng/dL) were treated with dexamethasone beginning at diagnosis (<10 days of age). Patients were also treated with fludrocortisone and sodium chloride. The average initial medication dose was 0.1 mg (<inline-formula><graphic file="1687-9856-2009-274682-i1.gif"/></inline-formula> <inline-formula><graphic file="1687-9856-2009-274682-i2.gif"/></inline-formula>); all doses were given in the morning using a dosing syringe to administer a 0.1 mg/mL elixir. The children were treated for <inline-formula><graphic file="1687-9856-2009-274682-i3.gif"/></inline-formula> years over which time the change in bone age to chronological age ratio (<inline-formula><graphic file="1687-9856-2009-274682-i4.gif"/></inline-formula>BA/<inline-formula><graphic file="1687-9856-2009-274682-i5.gif"/></inline-formula>CA) was <inline-formula><graphic file="1687-9856-2009-274682-i6.gif"/></inline-formula>. Most recent height <it>Z</it>' scores were <inline-formula><graphic file="1687-9856-2009-274682-i7.gif"/></inline-formula>, and body mass index (BMI) scores were <inline-formula><graphic file="1687-9856-2009-274682-i8.gif"/></inline-formula>. Late afternoon levels of 17-hydroxyprogesterone, androstenedione, and testosterone were <inline-formula><graphic file="1687-9856-2009-274682-i9.gif"/></inline-formula> ng/dL (<inline-formula><graphic file="1687-9856-2009-274682-i10.gif"/></inline-formula> nmol/L), <inline-formula><graphic file="1687-9856-2009-274682-i11.gif"/></inline-formula> ng/dL (<inline-formula><graphic file="1687-9856-2009-274682-i12.gif"/></inline-formula> nmol/L), and <inline-formula><graphic file="1687-9856-2009-274682-i13.gif"/></inline-formula> ng/dL; (<inline-formula><graphic file="1687-9856-2009-274682-i14.gif"/></inline-formula> nmol/L), respectively. <it>Conclusions</it>. These observations show that low doses of dexamethasone can be used to effectively treat CAH beginning in infancy.</p>