Endocrine Abstracts

Background: Attenuated adult height secondary to premature skeletal maturation is a potential complication of congenital adrenal hyperplasia (CAH) due to CYP21A2 mutation. Aromatase inhibitors such as letrozole may mitigate these effects by suppressing oestrogen production at the growth plate and slowing skeletal maturation. This study evaluated the safety and effectiveness of letrozole in improving adult height in male CAH patients with advanced bone age.

Methods: This retrospective case series included eight male patients with classic CAH and advanced bone age, who were treated with letrozole for a minimum of two years. Bone age, estimated adult height (EAH), EAH Z-score, hydrocortisone dosage and bone health index (BHI) were assessed at baseline and after two years of treatment. Statistical analyses were performed to determine the significance of changes in these parameters.

Results: Letrozole treatment was associated with a significant reduction in bone age Z-score from 2.89 at baseline to 1.52 at two years (P = 0.0097) and a corresponding improvement in EAH Z-score -0.84 to 0.08 (P = 0.0023). The mean EAH increased by approximately 7 cm at two years of treatment (P = 0.0047). There was no significant difference in mean BHI between baseline and 2 years of letrozole treatment (P = 0.93).

Conclusion: Letrozole may have a role in the management of male patients with CAH and advanced bone age, potentially improving adult height outcomes. Prospective controlled studies are needed to validate these findings and further evaluate the long-term safety and efficacy of aromatase inhibitors in this population.