HPA-minidosing for premature or exaggerated adrenarche
treatment
HPA-minidosing of premature and/or exaggerated adrenarche (PA) is based on established methods[1] of treatment for children with virilization caused by congenital adrenal hyperplasia (CAH). Check for signs that it is time to start treatment. In PA, the same approach is used, but with reduced dosing. For example, in a typical case of PA with excessive height velocity (exceding that expected for age and projected adult height, based on height of parents), 2mg/day prednisolone might be combined with 1/4 the typical CAH dose of aromatase inhibitor, and 1/10th the typical CAH dose of antiandrogen (depending on the degree of virilization).
Reduce adrenal androgens with bedtime prednisolone, antiandrogen, and aromatase inhibitor
Metformin may help reduce both weight and excess androgens in the overweight child.
If the gonads become activated (testicle length greater than 2cm in boys, or the presence of breast buds in girls), then HPG-minidosing is indicated.
If intervention is too late, as determined by testicular volume (boys) or breast buds (girls), only a GnRH analog can reverse full HPG axis activation.
(page continues below)
remember, FatherMag.com now comes in two editions:
Home Life <-|-> Home Strife
Ref.:
- Merke DP, Keil MF, Jones JV, et al.
Flutamide, testolactone, and reduced hydrocortisone dose maintain normal growth velocity and bone maturation despite elevated androgen levels in children with congenital adrenal hyperplasia.
The Journal of Clinical Endocrinology & Metabolism.
2000;85(3):1114-1120.
Back to puberty index page
Copyright © 2003 - 2008 FatherMag.com. All rights reserved.
|
fathermag.com