Endocrine Abstracts

Introduction: There is paucity of data comparing bone densitometry and body composition in adult women with congenital adrenal hyperplasia (CAH) treated with glucocorticoids since childhood and the same parameters in healthy women of the same age and BMI.

Methods: 20 women with classical CAH (35% simple virilizing, 65% salt losing), aged 16–45 years, had anthropometric, laboratorial and densitometry exam (DXA) for bone mineral density (BMD) (L1–L4, total femur and femoral neck). Laboratory determinations during follow-up were recorded and expressed as average levels. 18 control women of the same age and BMI as patients realized densitometric evaluation for mineral density and body composition.

Results: BMI ranged from16 to 41 kg/m² (average 26.3; 25% overweight and 30% obese), whereas height varied from136 to167 cm (average 151 cm). During follow-up, 35% patients were treated with prednisone as the sole glucocorticoid type, 50% used prednisone and dexamethasone and 15% other combinations. Average daily dose of prednisone was 7.5 mg (hydrocortisone equivalent dose 37 mg/day) and 70% used fludrocortisone (average 0.1 mg/day). Combined oral contraceptives were taken by 65% women. Half of women were not controlled based on average testosterone and androstenedione levels, 40% presented altered glycemic status, 26% elevated LDL cholesterol, 21% elevated triglycerides, 68% low HDL-cholesterol levels. No patient presented low BMD according to Z-score and compared to control group. Fat-free mass was considerably lower in patients than controls (33.726 vs 40.637 kg) and it correlated positively with testosterone levels (R 0.52, P 0.027). Women using fludrocortisone had lower body fat mass than women who used only glucocorticoids (34.3+12.3% vs 44.9+3.8%).

Conclusion: Adult women treated for classical congenital adrenal hyperplasia had important metabolic disturbances and alterations in body composition. Nevertheless bone mass was preserved, possibly because hyperandrogenism was not controlled most of the time.