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DOI: 10.1055/s-0030-1248309
© J. A. Barth Verlag in Georg Thieme Verlag KG Stuttgart · New York
Growth Impairment in a Boy with Late-Onset Congenital Adrenal Hyperplasia and Anorexia Nervosa[1]
Growth disorder in CAH with anorexia nervosa.Publikationsverlauf
received 24.01.2007
first decision 03.07.2007
accepted 11.07.2007
Publikationsdatum:
02. März 2010 (online)

Abstract
Treatment of congenital adrenal hyperplasia (CAH) in its salt-wasting form with appropriate doses of glucocorticoids and mineralocorticoids should promote growth, puberty and final height in a similar to normal pattern. However, the individual requirements for these drugs to normalize the hormonal profile and to achieve a physiologic growth pattern may differ. Moreover, the time of onset of puberty is also unpredictable since the course of the disease may predispose for precocity. The aim of this study was to explain the unexpected arrest of growth during puberty in a boy with late-onset CAH, who had been treated with glucocorticoid from early childhood. A short course of GnRH agonist treatment was also introduced in later years. The growth chart reflects two periods of impaired growth velocity preceded by weight loss. The reason for the first decline is difficult to prove retrospectively, but during the second episode the boy became both clinically and hormonally hypogonadal. At that time the anorexia nervosa (AN) was diagnosed according to APA DSM-IV criteria. We conclude that there were several reasons for the discontinued growth spurt and reduced final height in this boy with CAH: (a) early variant of puberty and subsequent late treatment with GnRH agonist, (b) AN possibly occurring during mid-childhood and clearly during puberty and (c) the repeated use of high doses of glucocorticoids. AN, a relatively rare disorder in boys, appears to have had a significant negative effect on this patient's growth and should be considered in the differential diagnosis in CAH children with impaired growth.
Key words
growth disorder - congenital adrenal hyperplasia - anorexia nervosa - precocity
1 Presented in part at the 37th International Symposium: GH and Growth Factors in Endocrinology and Metabolism, Athens, Greece, 4 – 5 March 2005.
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1 Presented in part at the 37th International Symposium: GH and Growth Factors in Endocrinology and Metabolism, Athens, Greece, 4 – 5 March 2005.
Correspondence
M. NiedzielaMD, PhD
Department of Pediatric Endocrinology and Diabetes
Poznan University of Medical Sciences
Szpitalna Street 27/33
60-572 Poznan
Poland
Telefon: +48/61/848 0291, 849 1481
Fax: +48/61/848 0291
eMail: mniedzie@am.poznan.pl