Endocrine Abstracts

Background: Patients with classical congenital adrenal hyperplasia (CAH) require life-long therapy with glucocorticoids in order to suppress the androgen production through the inhibition of CRH and consequently ACTH. The therapy must be balanced to avoid either iatrogen hypercortisolism or hyperandrogenism both potentially associated with adverse cardiovascular risk profile.

Objective: Aim of this cross-sectional controlled study was to investigate the metabolic risk profile in children and adolescents with classical CAH.

Subjects and methods: Twenty CAH patients (ten males and ten females, age range 9–19 years) and 20 age- and sex-matched healthy controls underwent clinical examination and lipids, blood pressure, fasting glucose concentrations, serum insulin levels and HOMA evaluation. Adiposity was expressed as BMI SDS. Waist circumference (WC) and waist-to-hip ratio (WHR) were used to evaluate visceral adiposity.

Results: BMI (0.9±0.9 vs −0.13±1.53; P=0.008), WC (82.9±13.7 vs 72.77±13.6; P=0.01), fasting insulin levels (12.0±7.6 vs 5.1±5.08; P=0.003) and HOMA index (2±1.34 vs 0.98±1.03; P=0.01) were significantly higher in CAH patients compared to controls. A significant relationship was observed between WC and BMI SDS (r=0.78, P<0.0001), fasting insulin levels (r=0.4525, P=0.04) and HOMA (r=0.45, P=0.04). No differences between the two groups were observed for lipid profile and blood pressure.

Conclusions: Our data suggest that children and adolescents with classical CAH may have a cluster of metabolic abnormalities that may place them at an increased risk of metabolic syndrome and cardiovascular disease. WC seems to be a good predictor of these metabolic abnormalities and therefore it should be routinely measured in the follow-up of patients with classical CAH.

Declaration of interest: The authors declare that there is no conflict of interest that could be perceived as prejudicing the impartiality of the research project.

Funding: This research did not receive any specific grant from any funding agency in the public, commercial or not-for-profit sector.