Management of fully pubertal girls with non-classical congenital adrenal hyperplasia - glucocorticoids vs. oral contraceptives.

Abstract

OBJECTIVE\nTo compare clinical outcomes of three treatment regimens, glucocorticoids (GCs), oral contraceptives (OCs), or a combination of both, administered to adolescents and young women diagnosed in childhood with non-classical congenital adrenal hyperplasia (NCCAH), who had been treated with GCs until their adult height (AHt) was achieved.\n\n\nMETHODS\nA retrospective study of medical records of 53 female patients with NCCAH followed in three tertiary pediatric endocrinology institutes. The three treatment groups were compared for prevalence of hirsutism and acne, standardized Body Mass Index (BMI SDS), and androgen levels at AHt (baseline), 1-year, and last documented visit.\n\n\nRESULTS\nAt baseline, there were no significant differences among groups in BMI-SDS, androgen levels, hirsutism prevalence, acne, or irregular menses. From baseline to last visit, rate of hirsutism declined significantly only in OCs group (37.5% vs. 6.2%, respectively, p=0.03). Rate of acne declined in the combined group (50% vs. 9%, respectively, p=0.03) with similar tendency in the OCs group (50% vs. 12.5%, respectively, p=0.05) . No significant changes were observed in BMI-SDS for the entire cohort or any subgroup during follow up. A significant rise in androstenedione (p<0.001), testosterone (p<0.01), and 17-hydroxyprogesterone (p<0.01) was observed only in OCs group.\n\n\nCONCLUSIONS\nIn girls diagnosed in childhood with NCCAH who require treatment for hyperandrogenism following completion of linear growth, management should be tailored individually using a patient-centered approach. OCs might be better than GCs treatment for regression of hirsutism and acne. The long-term effects of elevated androgens associated with this treatment regimen should be further studied.