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The classic form of 21-hydroxylase deficiency (prevalence 1/15,000) is the most common cause of congenital adrenal hyperplasia (CAH). This autosomic recessive disease is responsible for virilization of the external genitalia in girls through androgen hypersecretion during fetal life. Since 1984, the Lyon Pediatric Endocrinology group has proposed prenatal dexamethasone (DEX) for all fetuses at risk of CAH With the aim of preventing fetal androgen hypersecretion in affected girls and avoiding poor long-term results from reconstructive surgery. Prenatal DEX was used in Europe and the USA but its use was recently suspended: in 2007, a Swedish study conducted on 26 children treated with DEX in utero for a short period of time reported cognitive impairments. These data were not confirmed by an American study on the short-term DEX use, which showed potential cognitive impairments in CAH children exposed to DEX for long periods of time. These confusing and controversial results have caused the scientific community to question its position and have resulted in the suspension of the use of prenatal DEX with drastic consequences for CAH girls (virilization; genital surgery etc.). In this context, an evaluation of neuropsychological development under in utero DEX is essential to validate its indication for use during the prenatal period. This study will evaluate outcomes using prospective cognitive and emotional assessments. It will first focus on the unaffected children previously treated in utero in order to assess the adverse effects of the drug. The study will then assess the children with CAH for whom DEX could have beneficial effects.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Group D+ 1 | Experimental | Girls and boys at risk of CAH treated in utero by Dexamethasone but unaffected. |
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| Group D+ 2 | Experimental | Girls and boys affected by CAH and treated in utero by Dexamethasone. |
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| : Group D - 1 | Active Comparator | Girls and boys not affected by CAH and not treated in utero by Dexamethasone. |
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| Group D - 2 | Active Comparator | Girls and boys affected by CAH and not treated in utero by Dexamethasone. |
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| Group D - 3 | Other | Girls and boys enrolled in school closed to Lyon |
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| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Neuropsychological and cognitive assessment | Behavioral |
|
| Measure | Description | Time Frame |
|---|---|---|
| Intelligence quotient | Wechsler Intelligence Scale for Children (WISC) is designed to measure human intelligence. WISC-IV includes:
The four indexes of the intelligence quotient will be considered hierarchically as follows: first the Working Memory Index, then the Processing Speed Index, third the Perceptual Reasoning Index, fourth the Verbal Comprehension Index. | 3 months |
| Measure | Description | Time Frame |
|---|---|---|
| Children Memory Scale (CMS) | Neurocognitive profile of children assessed by Children Memory Scale (CMS) at Visit 2. Memory tests: Children Memory Scale (CMS), the following composites will be considered in our study:
|
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Inclusion Criteria:
Groups D+1, D+2, D-1 and D-2
Group D-3 (Schoolchildren)
Exclusion Criteria:
For all groups :
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| Name | Affiliation | Role |
|---|---|---|
| Véronique TARDY-GUIDOLLET, MD PHD | Groupement Hospitalier Est - Laboratoire d'endocrinologie moléculaire et maladies rares - Centre de biologie et de pathologie Est. | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Service d'endocrinologie pédiatrique, CHU de Besançon | Besançon | France | ||||
| Service d'endocrinologie pédiatrique, CHU de Bordeaux |
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| ID | Term |
|---|---|
| D000312 | Adrenal Hyperplasia, Congenital |
| ID | Term |
|---|---|
| D047808 | Adrenogenital Syndrome |
| D012734 | Disorders of Sex Development |
| D014564 | Urogenital Abnormalities |
| D052776 | Female Urogenital Diseases |
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| 3 months |
| Rey figure test | Neurocognitive profile of children assessed by visuoperceptual test (Rey Figure test) at Visit 2 | 3 months |
| Revised - Child Measure of Anxiety Scale (R- CMAS) score | Emotional profile assessed by Revised - Child Measure of Anxiety Scale (R- CMAS) score | 15 months |
| Mood Depressive Inventory for Children (MDI- C) score | Emotional profile assessed by Mood Depressive Inventory for Children (MDI- C) score | 15 months |
| Child Behavior Checklist (CBCL) score | Emotional profile assessed by Child Behavior Checklist (CBCL) score | 15 months |
| Evaluation of the benefits of in utero DEX in preventing or reducing the virilization of external genitalia in CAH girls | The anatomical evaluation (phenotyping) of girls' external genitalia was performed at the time of the surgical correction and included the measurement of the genital tubercule (GT), the distance between the perineum and the urethra-vaginal confluence, the degree of fusion of the genital folds (labia majora), their pigmentation and creases. The measurement of the ano-genital distance was not routine practice in the past. | Day 1 |
| Bordeaux |
| France |
| Groupement Hospitalier Est - Laboratoire d'endocrinologie moléculaire et maladies rares - Centre de biologie et de pathologie Est. 59 boulevard Pinel | Bron | 69677 | France |
| Service d'endocrinologie pédiatrique, CHU de Grenoble | Grenoble | France |
| Service d'endocrinologie pédiatrique, CHRU de Lille | Lille | France |
| Service d'endocrinologie pédiatrique, Hopital de la Timone, APHM | Marseille | France |
| Service d'endocrinologie pédiatrique, CHU de Nantes | Nantes | France |
| Service d'endocrinologie pédiatrique, CHU de Nice | Nice | France |
| Service d'endocrinologie pédiatrique, Hôpital Armand Trousseau, AP-HP | Paris | France |
| Service d'endocrinologie pédiatrique, CHU de Reims | Reims | France |
| D005261 | Female Urogenital Diseases and Pregnancy Complications |
| D000091642 | Urogenital Diseases |
| D052801 | Male Urogenital Diseases |
| D000013 | Congenital Abnormalities |
| D009358 | Congenital, Hereditary, and Neonatal Diseases and Abnormalities |
| D030342 | Genetic Diseases, Inborn |
| D043202 | Steroid Metabolism, Inborn Errors |
| D008661 | Metabolism, Inborn Errors |
| D008659 | Metabolic Diseases |
| D009750 | Nutritional and Metabolic Diseases |
| D000307 | Adrenal Gland Diseases |
| D004700 | Endocrine System Diseases |
| D006058 | Gonadal Disorders |