Adult Height and Fertility in Men with Congenital Virilizing Adrenal Hyperplasia

The effects of congenital adrenal hyperplasia on adult height and fertility were studied in 30 afflicted men. The patients’ heights ranged from 150.0 to 178.6 cm (mean ±1 S.D. of 164.0±7.6), which is significantly lower than both the mean adult height for American men and that of the patients’ parents (P<0.005). There was no correlation between adult height and the age at which therapy was begun, possibly because the patients treated before one year of age had the salt-losing form of the syndrome. Therapeutic compliance may also have been involved. Apparently normal fertility, indicated by paternity and normal sperm counts, was found in 18 out of 20 patients evaluated. This group included five untreated patients who were found to be fertile and to have normal plasma testosterone and gonadotropin but elevated androstenedione levels. (N Engl J Med 299:1392–1396, 1978) IT has been more than 25 years since glucocorticoid therapy was first introduced in the management of patients with congenital virilizing adrenal hyperplasia.¹² Long-term follow-up data are accumulating as the first generation of treated patients enters adulthood.^{3 4 5 6 7 8} However, information published to date concerns mainly female patients with congenital adrenal hyperplasia. As shown by Childs et al.,⁹ the frequency of congenital adrenal hyperplasia is approximately the same in both sexes. Failure to recognize the disorder in some male patients with the simple virilizing form accounts for the predominance of female patients followed in most pediatric endocrine clinics. We undertook this study.