Irene Astrid Larasati¹, Agustini Utari², Hedi L. Claahsen – van der Grinten³, Tri Indah Winarni⁴

(1) Department of Medicine, Doctor of Medicine and Health Study Program, Faculty of Medicine, Universitas Diponegoro, Semarang, Indonesia.

(2) Department of Pediatrics, Department of Pediatrics, Division of Pediatric Endocrinology, Faculty of Medicine, Universitas Diponegoro, Semarang, Indonesia.

(3) Department of Pediatrics, Department of Pediatrics, Division of Pediatric Endocrinology, Amalia Children’s Hospital, Radboud University Medical Centre, Nijmegen, Netherlands.

(4) Department of Anatomy, Center for Biomedical Research, Faculty of Medicine, Universitas Diponegoro, Semarang, Indonesia.

Background

Early diagnosis and treatment are keys to ensure satisfying outcomes in congenital adrenal hyperplasia (CAH). Discrepancy in availability and access to healthcare between regions, in addition to a high mortality rate due to adrenal crisis, remains a challenge in Asian countries. This review aims to elucidate final height as an outcome measure to evaluate the quality of care in CAH individuals in Asia.

Methods

Observational studies published from 1954 until August 2025 were included in the review. Databases, i.e., PubMed, Scopus, and ProQuest, and references from included studies were sought. Two reviewers worked in duplicate to screen, appraise, and synthesize data utilizing the estimates of mean standard deviation score (SDS) following PRISMA and SWiM Guidelines.Results. Eight studies (West Asia=1; South Asia=2; East Asia=7), most of which were retrospective cohorts, were included. Sample sizes ranged from 6 to 78 individuals who achieved final height (FH). The mean FH SDS ranged from -2.50 to -1.09, with the SD ranging from 0.85 to 1.58. The mean corrected FH SDS ranged from -1.95 to -0.(SD 0.90-1.57). All individuals were treated with conventional therapy (i.e., glucocorticoids and mineralocorticoids). Only one study reported the diagnosis of all participants through newborn screening.

Conclusions

This study exemplified low FH, even corrected with genetic potential, in CAH individuals compared to norms in Asia suggesting a lack of necessary infrastructure and suboptimal care. Elaborate strategies are needed to improve CAH individuals’ outcomes across Asia.