Vol 72, No 4 (2021)
Original paper
Published online: 2021-04-13

open access

Page views 1651
Article views/downloads 680
Get Citation

Connect on Social Media

Connect on Social Media

The validity of the Bayley-Pinneau method in predicting final adult height at the onset of puberty in patients with classic congenital adrenal hyperplasia

Nora Badawi1, Lubna Fawaz1, Ahmed Amin1, Abdelkarim Kamel2, Noha Arafa1
Pubmed: 34010438
Endokrynol Pol 2021;72(4):301-307.


Introduction: The final adult height (FAH) of patients with congenital adrenal hyperplasia (CAH) is often lower than the predicted adult height (PAH) using the Bayley-Pinneau (B&P) method. The aim of the current work was to test the validity of B&P in predicting FAH from a bone age (BA) measurement performed at onset of puberty.

Material and ethods: This was a retrospective longitudinal observational convenience single-centre study. The study included 54 patients (male and female) with classic CAH, whether salt-wasting (SW) or simple virilising (SV), who had reached FAH. The results of auxological measurements and hormonal data around the time of puberty were retrieved from files. Predicted adult height (PAH) was calculated from a BA taken at onset of puberty and compared with FAH.

 Results: The median PAH SDS at the onset of puberty (–1.5) was significantly greater than the median FAH SDS (–2.2) (p < 0.001). The median target height SDS (–0.8) was significantly higher than the median FAH SDS (–2.2) (p < 0.001). FAH and FAH SDS were significantly worse in females (150.36 ± 7.23; –2.05 ± 1.13) than in their male counterparts (162.86 ± 3.30; –1.53 ± 0.51) (p value < 0.001; 0.048). In patients with good control, there was no difference between PAH SDS (–1.7) and FAH SDS (–1.5) (p value = 0.37). In patients with poor control (over- or under-treated) FAH SDS (–2.1) was significantly lower than PAH SDS (–1.4) (p value < 0.001).

Conclusion: The B&P method was able to accurately predict FAH in children with classic CAH, who were medically well controlled (based on 17-hydroxyprogesterone levels), but overestimated it by a significant 0.7 SD in poorly-controlled patients.

Article available in PDF format

View PDF Download PDF file


  1. Bonfig W, Odenwald B, Nennstiel-Ratzel U, et al. Blood pressure, fludrocortisone dose and plasma renin activity in children with classic congenital adrenal hyperplasia due to 21-hydroxylase deficiency followed from birth to 4 years of age. Clin Endocrinol (Oxf). 2014; 81(6): 871–875.
  2. Tayel SM, Ismael H, Kandil H, et al. Congenital Adrenal Hyperplasia in Alexandria, Egypt: A High Prevalence Justifying the Need for a Community-based Newborn Screening Program. J Trop Pediatr. 2010; 57(3): 232–234.
  3. Tayel SM, Ismael H, Kandil H, et al. Congenital adrenal hyperplasia in Alexandria, Egypt: a high prevalence justifying the need for a community-based newborn screening program. J Trop Pediatr. 2011; 57(3): 232–234.
  4. Merke DP, Poppas DP. Management of adolescents with congenital adrenal hyperplasia. Lancet Diabetes Endocrinol. 2013; 1(4): 341–352.
  5. Speiser PW, Azziz R, Baskin LS, et al. Endocrine Society. Congenital adrenal hyperplasia due to steroid 21-hydroxylase deficiency: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2010; 95(9): 4133–4160.
  6. Seth A. Optimizing Stature in Congenital Adrenal Hyperplasia: Challenges and Solutions. Indian J Pediatr. 2019; 86(6): 489–491.
  7. Speiser PW, Arlt W, Auchus RJ, et al. Congenital Adrenal Hyperplasia Due to Steroid 21-Hydroxylase Deficiency: An Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab. 2018; 103(11): 4043–4088.
  8. Tarim O. Accuracy of height prediction by Bayler Pinneau method. J Pediatr Endocrinol. 2016; 1: 1002.
  9. Tanner JM, Whitehouse RH. Clinical longitudinal standards for height, weight, height velocity, weight velocity, and stages of puberty. Arch Dis Child. 1976; 51(3): 170–179.
  10. Hargitai G, Sólyom J, Battelino T, et al. Growth Patterns and Final Height in Congenital Adrenal Hyperplasia due to Classical 21-Hydroxylase Deficiency. Horm Res Paed. 2001; 55(4): 161–171.
  11. Aycan Z, Bas VN, Cetinkaya S, et al. Prevalence and long-term follow-up outcomes of testicular adrenal rest tumours in children and adolescent males with congenital adrenal hyperplasia. Clin Endocrinol (Oxf). 2013; 78(5): 667–672.
  12. Hiernaux J, Tanner JM. Growth and physique: anthropometry. In: Weiner JS, Lourie JA. ed. Human biology, a guide to field methods. Davis Company, Philadelphia 1969: 2–42.
  13. Greulich WW, Pyle SI. Radiographic Atlas of Skeletal Development of the Hand and Wrist. 2nd ed. Stanford University Press, Stanford 1959.
  14. Bayley N, Pinneau SR. Tables for predicting adult height from skeletal age: revised for use with the Greulich-Pyle hand standards. J Pediatr. 1952; 40(4): 423–441.
  15. Merke DP. Approach to the adult with congenital adrenal hyperplasia due to 21-hydroxylase deficiency. J Clin Endocrinol Metab. 2008; 93(3): 653–660.
  16. Lin-Su K, Harbison MD, Lekarev O, et al. Final adult height in children with congenital adrenal hyperplasia treated with growth hormone. J Clin Endocrinol Metab. 2011; 96(6): 1710–1717.
  17. Martin DD, Wit JM, Hochberg Z, et al. The use of bone age in clinical practice - part 2. Horm Res Paediatr. 2011; 76(1): 10–16.
  18. Trinh L, Nimkarn S, New MI, et al. Growth and pubertal characteristics in patients with congenital adrenal hyperplasia due to 21-hydroxylase deficiency. J Pediatr Endocrinol Metab. 2007; 20(8): 883–891.
  19. Klingensmith GJ, Garcia SC, Jones HW, et al. Glucocorticoid treatment of girls with congenital adrenal hyperplasia: effects on height, sexual maturation, and fertility. J Pediatr. 1977; 90(6): 996–1004.
  20. Charmandari E, Brook CGD, Hindmarsh PC. Classic congenital adrenal hyperplasia and puberty. Eur J Endocrinol. 2004; 151 Suppl 3: U77–U82.
  21. Papadakis G, Kandaraki EA, Tseniklidi E, et al. Polycystic Ovary Syndrome and NC-CAH: Distinct Characteristics and Common Findings. A Systematic Review. Front Endocrinol (Lausanne). 2019; 10: 388.
  22. Lin YC, Lin CY, Chee SY, et al. Improved final predicted height with the injection of leuprolide in children with earlier puberty: A retrospective cohort study. PLoS One. 2017; 12(10): e0185080.
  23. Bonfig W, Pozza SB, Schmidt H, et al. Hydrocortisone dosing during puberty in patients with classical congenital adrenal hyperplasia: an evidence-based recommendation. J Clin Endocrinol Metab. 2009; 94(10): 3882–3888.
  24. Girgis R, Winter JS. The effects of glucocorticoid replacement therapy on growth, bone mineral density, and bone turnover markers in children with congenital adrenal hyperplasia. J Clin Endocrinol Metab. 1997; 82(12): 3926–3929.
  25. Muthusamy K, Elamin MB, Smushkin G, et al. Clinical review: Adult height in patients with congenital adrenal hyperplasia: a systematic review and metaanalysis. J Clin Endocrinol Metab. 2010; 95(9): 4161–4172.
  26. Bozzola M, Meazza C. Growth velocity curves: What they are and how to use them. In: Preedy V. ed. Handbook of Growth and Growth Monitoring in Health and Disease. Springer, New York 2012: 2999–3011.
  27. Lin-Su K, Harbison MD, Lekarev O, et al. Treatment with growth hormone and luteinizing hormone releasing hormone analog improves final adult height in children with congenital adrenal hyperplasia. J Clin Endocrinol Metab. 2005; 90(6): 3318–3325.
  28. Tarim O. Height predictions by Bayley-Pinneau method may misguide pediatric endocrinologists. Turkish J Pediatr . 2013; 55 (5): 485–492.
  29. Al Shaikh A, AlGhanmi Y, Awidah S, et al. Clinical Patterns and Linear Growth in Children with Congenital Adrenal Hyperplasia, an 11-Year Experience. Indian J Endocrinol Metab. 2019; 23(3): 298–306.
  30. Sarafoglou K, Forlenza GP, Yaw Addo O, et al. Obesity in children with congenital adrenal hyperplasia in the Minnesota cohort: importance of adjusting body mass index for height-age. Clin Endocrinol (Oxf). 2017; 86(5): 708–716.
  31. Nguyen AnTt, Brown JJ, Warne GL. Growth in congenital adrenal hyperplasia. Indian J Pediatr. 2006; 73(1): 89–93.
  32. Cordeiro GV, Silva IN, Goulart EM, et al. Final height in congenital adrenal hyperplasia: the dilemma of hypercortisolism versus hyperandrogenism. Arq Bras Endocrinol Metabol. 2013; 57(2): 126–131.
  33. Sellick J, Aldridge S, Thomas M, et al. Growth of patients with congenital adrenal hyperplasia due to 21-hydroxylase in infancy, glucocorticoid requirement and the role of mineralocorticoid therapy. J Pediatr Endocrinol Metab. 2018; 31(9): 1019–1022.
  34. Kim MS, Ryabets-Lienhard A, Geffner ME. Management of congenital adrenal hyperplasia in childhood. Curr Opin Endocrinol Diabetes Obes. 2012; 19(6): 483–488.
  35. Manoli I, Kanaka-Gantenbein Ch, Voutetakis A, et al. Early growth, pubertal development, body mass index and final height of patients with congenital adrenal hyperplasia: factors influencing the outcome. Clin Endocrinol (Oxf). 2002; 57(5): 669–676.
  36. Pijnenburg-Kleizen KJ, Thomas CMG, Otten BJ, et al. Long-term follow-up of children with classic congenital adrenal hyperplasia: suggestions for age dependent treatment in childhood and puberty. J Pediatr Endocrinol Metab. 2019; 32(10): 1055–1063.