Treatment of virilizing congenital adrenal hyperplasia (VCAH) with short-acting glucocorticoids may be associated with compromised adult stature. To assess if dexamethasone treatment of VCAH is associated with more favorable statural outcomes, we examined growth in 14 boys and 8 girls with VCAH treated with dexamethasone. At the onset of therapy, males were 2.8 ± 0.8 yrs of age (X ± SEM) and females were 3.4 ± 1.0 yrs. Patients were treated with fludrocortisone and a morning dose of dexamethasone (0.27± 0.01 mg/m2). Males were treated for 7.3 ± 1.1 yrs(ΔCA) over which time the ΔBA (bone age) was 7.0 ± 1.3 yrs, and the ΔHA (height age) was 6.9 ± 1.1 yrs. Females were treated for 5.6 ± 1.3 yrs over which time the ΔBA was 6.2 ± 2.0 yrs, and the ΔHA was 6.5 ± 0.8 yrs. Male mature heights were 167.3 ± 5.0 cm for 4 individuals; predicted adult heights from Bayley-Pinneau tables were 174.4 ± 0.8 cm for 6 others. Female mature heights were 155.7 cm for 2 individuals; predicted adult heights were 159.1± 2.5 cm for 5 others. Mature and predicted adult height standard deviation scores were -0.93 ± 0.43 and -0.63 ± 0.49 SD for males and females, respectively. When compared with midparental heights, mature and predicted adult heights for males were 4.9 ± 0.1 cm below (-0.6 SD, n=5) and female heights were 2.2 ± 0.1 cm above (+0.3 SD; n=5) above their genetic growth potential. These observations suggest that children treated with dexamethasone for VCAH can achieve normal growth with the convenience of once-a-day dosing.