AI Article Synopsis

  • Children with congenital adrenal hyperplasia (CAH) are at risk for early puberty, and Gonadotropin-releasing hormone analog (GnRHa) is commonly used to manage this condition despite concerns about bone mineral density (BMD).
  • A study was conducted with 61 patients with classic CAH, comparing BMD outcomes between those treated with GnRHa and those who were not, finding no significant differences in BMD at adult height.
  • While GnRHa treatment did not negatively impact BMD, there was a noted overall decrease in BMD as patients aged, which may be linked to long-term glucocorticoid use, but the treatment positively influenced height outcomes.

Article Abstract

Context: Children with congenital adrenal hyperplasia (CAH) are at risk for early puberty. Gonadotropin-releasing hormone analog (GnRHa) is frequently used and can decrease bone mineral density (BMD).

Objective: Our aim was to investigate the effect of GnRHa therapy on BMD in a longitudinal study of patients with CAH spanning both childhood and adulthood.

Design And Setting: Sixty-one patients with classic CAH due to 21-hydroxylase deficiency (20 treated with GnRHa) were followed with dual-energy X-ray absorptiometry (DXA) scans at puberty onset, attainment of adult height, and during early adulthood.

Main Outcome Measures: Whole body, lumbar spine, femoral neck, total hip, and distal radius BMD z-score at adult height. Longitudinal BMD and adult height were also assessed.

Results: Twenty patients received GnRHa for an average of 4.5 ± 2 years. There were no differences in BMD between GnRHa-treated and -untreated groups at adult height for all sites. Overall, the follow-up DXA during early adulthood showed decreases in BMD z-scores for whole body (P = .01), lumbar spine (P < .0001), femoral neck (P = .06), total hip (P = .009), and distal radius (P = .05). GnRHa treatment correlated with improved height outcomes compared to predicted height at puberty onset after adjusting for midparental height (P = .02). Patients in both groups achieved similar adult height.

Conclusion: In children with CAH, GnRHa does not compromise BMD. However, BMD decreases with time and during the second and third decades of life is a possible effect of chronic supraphysiologic glucocorticoids. Children with CAH who experience early puberty benefit from GnRHa treatment as evidenced by the positive effect on height.

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Source
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC10795903PMC
http://dx.doi.org/10.1210/clinem/dgad514DOI Listing

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