Height outcome in congenital adrenal hyperplasia caused by 21-hydroxylase deficiency: a meta-analysis

Objective: To investigate adult heights attained by patients with 21-hydroxylase deficiency and to perform a meta-analysis of height outcomes reported in this population. Study design: A retrospective chart review of our patients >5 years of age (n = 65) who were followed up from 1978 to 1998 for 21-hydroxylase deficiency was conducted. Final height (FH) SD scores and target height (TH) SD scores were determined. The impact of sex, time of diagnosis, and compliance was assessed. Meta-analysis of results from 18 studies was performed; TH was available for 204 of 561 patients. Results: Mean FH SD score–TH SD score for our 65 patients was –1.03. For the meta-analysis, mean weighted FH SD score for all 561 patients was –1.37, whereas weighted mean FH SD score–TH SD score for the 204 patients for whom TH was available was –1.21. No difference in outcome was seen for males compared with females, although a statistically significant difference was seen for patients identified early versus late. Conclusions: Adult height in patients with 21-hydroxylase deficiency is often within 1 SD of TH. Early diagnosis and good compliance appear to improve the outcome. Rather than pursuing alternate therapies for congenital adrenal hyperplasia, efforts may instead be focused on early detection and improved compliance with traditional medical therapy. (J Pediatr 2001;138:26-32)