Adult Height in Patients with Congenital Adrenal Hyperplasia: A Systematic Review and Metaanalysis

Context: Treatment for patients with congenital adrenal hyperplasia (CAH) may affect the final height of these patients. Objective: Our objective was to determine the distribution of achieved height in patients with classic CAH diagnosed at infancy or early childhood and treated with glucocorticoids. Data Sources: We searched MEDLINE, EMBASE, Cochrane Library, ISI Web of Science, and Scopus through September 2008; the reference sections of included studies; and expert files. Study Selection: Eligible studies included patients diagnosed with CAH before age 5 and followed to final height. Data Extraction: Reviewers working in duplicate independently extracted data on study characteristics and outcomes and determined each study's risk of bias. Data Synthesis: The SD score (SDS) for final height and corrected height (defined as final height SDS - midparental height SDS) were estimated from each study and pooled using random-effects metaanalysis. The I-2 statistic was used to assess inconsistency in results across studies. Results: We found 35 eligible studies, most of which were retrospective single-cohort studies. The final height SDS achieved by CAH patients was -1.38 (-1.56 to -1.20; I-2 = 90.2%), and the corrected height SDS was -1.03 (-1.20 to -0.86; I-2 = 63.1%). This was not significantly associated with age at diagnosis, gender, type and dose of steroid, and age of onset of puberty. Mineralocorticoid users had a better height outcome in comparison with the nonusers (P = 0.02). Conclusion: Evidence derived from observational studies suggests that the final height of CAH patients treated with glucocorticoids is lower than the population norm and is lower than expected given parental height. (J Clin Endocrinol Metab 95: 4161-4172, 2010)