standard of care treatment of congenital adrenal hyperplasia, discussed
in the 16th edition of Nelson's Textbook of Pediatrics, uses hydrocortisone
three times a day dosing of 8-20mg/m2/day with careful monitoring of
bone age, and adrenal androgen levels.(2)
is rapidly eliminated from the circulation, requiring 3 or 4 times a
day dosing. It has been associated with breakthrough adrenal androgen
secretion resulting in below average adult and midparental heights.
loss in adult stature associated with hydrocortisone therapy is believed
to reflect cumulative adverse effects on growth and inadequate suppression
of adrenal androgen secretion.
- It has
been suggested that because of dexamethasone's long half-life, it can
provide more continuous suppression of adrenal androgen secretion in
CAH compared to hydrocortisone.
advantage of using dexamethasone, according to this study, is that missing
one dose of dexamethasone does not cause adrenal secretion excess. In
comparison, missing or delaying a dose of hydrocortisone results in
adrenal secretion excess which may affect growth as well as other symptoms
associated with androgen excess.
Rivkees S, Crawford J. Dexamethasone Treatment of Virilizing Congenital
Adrenal Hyperplasia: The Ability to Achieve Normal Growth. Pediatrics
Behrman. Nelson Textbook of Pediatrics, 16th Edition; 2000: 1729-1743.