Cognitive and social function in girls with congenital adrenal hyperplasia -- influence of prenatally administered dexamethasone.

OBJECTIVES: To assess the cognitive, social, and emotional function in girls prenatally treated with dexamethasone (Dex) due to congenital adrenal hyperplasia (CAH), compared to CAH female patients not treated prenatally. PATIENTS AND METHODS: 33 girls from CAH families were studied: 17 girls treated prenatally with Dex (9 CAH-affected and 8 non-CAH-affected) and 16 CAH-affected females prenatally untre-ated. Standardized tests to assess cognitive function, tests of memory and learning process, and the Child Behavior Checklist (CBCL) were used. RESULTS: There were few statistically significant differences between the results of treated girls (CAH-affected and unaffected) and CAH untreated patients, with a tendency for better results in all tests by Dex treated girls. Among three groups- "CAH-unaffected treated," "CAH-affected treated," and "CAH-affected untreated"- the best results were found in "CAH-affected treated" in almost all tests. The Wechsler test performance scale was significantly higher in treated CAH-affected girls. The comparison between treated and untreated CAH-affected girls revealed better results in all tasks involving the cognitive function in Dex-treated patients. Poor performance in visual perception, analysis of spatial material, and visual memory tasks were obtained in CAH-unaffected treated girls. CONCLUSIONS: Prenatal treatment with Dex creates for CAH-affected females better conditions for cognitive development. The prenatal Dex in CAH-unaffected girls can cause the risk of unfavorable influences on the development of some cognitive functions. Therefore, it is recommended that prenatal treatment in CAH-unaffected female fetuses should be stopped as soon as possible after the exclusion of the disease.

Cognitive and social functioning in children and adolescents after the removal of craniopharyngioma.

PURPOSE: The aim of this study is to assess cognitive, emotional and social functioning in children and adolescents after the removal of craniopharyngioma. METHODS: Twenty-seven children operated for craniopharyngioma and their parents participated in the study. Cognitive functions were assessed with WISC-R/WAIS-R-PL and Rey-Osterrieth Complex Figure Test. Parents completed Achenbach's Child Behaviour Checklist (CBCL) questionnaires on problems in functioning and psychopathological symptoms and took part in an interview on children coping in everyday life. RESULTS: Eighty-two percent of patients were diagnosed with an average level of intellectual functioning. No child received results indicating mental disability. In half of the children, effectiveness of visual memory was reduced, despite normal visual-spatial abilities. The results in the CBCL scale indicated more frequent presence of psychopathological symptoms-especially social problems, depression, anxiety and withdrawal. The most frequent problems in children's everyday functioning included inability to control emotions, difficulties in learning, unsatisfactory peer relationships, and unattractive appearance resulting from hormonal disorders (short height and obesity). One third of parents also reported problems with pathological appetite in their children. CONCLUSIONS: Despite normal intellectual abilities and relatively good physical condition, children after removal of craniopharyngioma experience many difficulties in everyday life regarding social relationships, emotion control and learning. The analogy between the above-mentioned symptoms and symptoms observed in patients after infantile damage in the frontal area leads to an observation that, apart from endocrine disorders, damage to the frontal lobe caused by the growth of tumour and operational intervention is of crucial importance to the further development of children with craniopharyngioma.