TOPLINE

Among patients with congenital adrenal hyperplasia (CAH) who had reached their near-final height, height fell short of population and parental expectations, with numerically greater shortfalls in the salt-wasting form. Bone age and growth speed patterns pointed to a critical window between approximately 6 and 10 years of age for closer monitoring, and higher hydrocortisone doses were associated with poorer growth outcomes.

METHODOLOGY

• Researchers conducted a retrospective, observational study at a paediatric endocrinology centre to assess near-final height and factors linked to growth outcomes in patients with CAH caused by 21-hydroxylase deficiency.
• They reviewed 2949 clinic visits from 63 patients (48% boys) who reached their near-final height at a median age of about 16 years, tracked across nearly three decades, from 1996 to 2025.
• Patients were grouped on the basis of their clinical phenotype as either salt wasting (SW; n = 45) or non-SW (n = 18), with the non-SW group including those with simple virilising or non-classic CAH and no documented SW.
• Near-final height was defined as the height recorded once a patient met at least one of three signs indicating that growth had essentially stopped: reaching the age of 18 years, having a bone age of 16 years or older, or growing < 1 cm/y. A corrected version of this measure was also calculated, adjusting for each child's target height based on their parents' heights.
• The researchers tracked bone age advancement, height velocity, puberty onset, BMI, and hydrocortisone dosing over time to identify which factors — and which periods of childhood — most influenced final adult height.

TAKEAWAY

• Overall, patients had a mean near-final height 1.20 SD below the population norm. Their corrected near-final height SD score was -0.87, compared with a target height SD score of -0.33. The corrected near-final height SD score was lower in the SW group than in the non-SW group (mean, -0.99 vs -0.57); however, the difference was not significant.
• Bone age advancement accelerated from around 6 years of age and peaked by around 10 years of age, identifying a potentially important period for closer monitoring, although bone age advancement itself was not an independent predictor of near-final height.
• Height velocity during puberty was blunted in both groups rather than showing the usual adolescent spurt, and around a third of children showed early signs of puberty; however, when puberty started did not significantly affect the corrected near-final height.
• Higher average hydrocortisone doses and short-term dose increases were each associated with lower height SD scores over time (P = .035 and P < .001, respectively). BMI trajectories showed an early adiposity rebound at around 3.4 years of age in both groups, earlier than expected in healthy children.

IN PRACTICE

"[The period between approximately 6 and 10 years of age] may represent the optimal time for intensified androgen suppression and potential introduction of aromatase inhibitors to reduce estrogen-mediated BA [bone age] advancement and improve height outcomes," the authors wrote.

"These findings should be interpreted cautiously because of potential residual confounding, changes in treatment practices over time, and incomplete information on biochemical control, longitudinal adherence, and socioeconomic factors," they added.

SOURCE

This study was led by Zuzanna Gawlik, University Children's Hospital of Kraków, Kraków, Poland. It was published online on September 30, 2026, in the European Journal of Pediatrics.

LIMITATIONS

The single-centre design and the relatively small sample size may have limited the generalisability of the findings. Limited access to biochemical monitoring markers and newer hydrocortisone formulations may have restricted the assessment of disease control and treatment effects. Treatment adherence was not assessed, so the association between higher hydrocortisone doses and poorer height outcomes should have been interpreted cautiously.

DISCLOSURES

The authors did not receive any specific funding for this study and declared having no competing interests.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.