Clinical evidence, practical contradictions, and monitoring of rhGH-assisted height enhancement in children with CAH

Due to the condition itself and long-term glucocorticoid medication, children with congenital adrenal hyperplasia (CAH) frequently experience secondary impairment of adult height. Recombinant human growth hormone (rhGH) has been tried to improve growth outcomes either by itself or in conjunction with gonadotropin-releasing hormone analogs; however, there is currently insufficient evidence to support its safety and effectiveness. Six clinical trials in this area are thoroughly reviewed in this article, which highlights the fact that the majority of the evidence currently available comes from small-sample, nonblinded designs. Although rhGH can improve projected or ultimate adult height in the near term, long-term metabolic and tumor concerns are still understood. The ambiguity of treatment indications, the significant financial burden, and the uncertainty surrounding long-term safety are the three main practical inconsistencies in the therapeutic application of rhGH that are examined in this paper. A monitoring index framework including growth and development, endocrine metabolism, and systemic safety is suggested based on this information as well as prior research and clinical experience. This article concludes by emphasizing the need for future large-scale prospective studies and patient registration systems to elucidate the risk-benefit ratio of rhGH in various CAH populations and to pay attention to the potential growth-improving effects of novel therapies represented by CRF1 receptor antagonists. The purpose of this article is to give doctors evidence-based, contradiction-aware, and safety-focused decision-making references for controlling the height of CAH children with rhGH.