Endocrine Abstracts

Introduction: Management of patientswith congenital adrenal hyperplasia (CAH) is a challenge to find a right balance of glucocorticoid doses and long-term consequences of overtreatment isassociated with increased risk of cardiometabolic disorders.

The aim of our study was to evaluate body mass index (BMI), body composition, blood pressure (BP) and insulin sensitivity in children and youth with CAH in comparison with healthy control subjects.

Methods: Data from 29 patients with CAH (13 males; median age 16.9 ± 6.8, years (10.2–30.9)) were collected retrospectively and compared to 29 healthy controls (14 males; median age 20.2 ± 0.9 years (17.7–21.3), P = 0.13). 21 patient had salt-wasting (SW 11 males) and 8 patients - simple virilising (SV, 71 male) form of CAH. Median dose of hydrocortisone (HC) was calculated from CAH diagnosis until last examination. Prednisolone and dexamethasone doses were converted to equivalent HC doses in mg/m² per day using standard GC equivalencies (20 mg of HC = 5 mg of prednisolone = 0.4 mg of dexamethasone). Body composition was evaluated in both groups with DXA (Hologic Inc., Bedford, MA, USA). Hypertension was defined as BP >95 percentile in children and adolescents and >140/90 mmHg in adults). Comparisons between two groups were adjusted for age, gender and height. Oral glucose tolerance test (OGTT) was performed and fasting insulin level were evaluated in the CAH group. Insulin sensitivity was determined using homeostasis model assessment of insulin resistance index (HOMA-IR).

Results: Mean BMI was significantly higher in subjects with CAH (1.18 ± 1.3 SDS and 0.18 ± 1.05 SDS, respectively, P = 0.002). Total body fat (TBF) mass Z-score was significantly higher in CAH patients vs controls (0.629 ± 0.80 vs −0.04 ± 0.76, P = 0.003). Mean total daily dose of HC in the SW group was 15.4 ± 2.3 (11.03–21.41) and in the SV group 14.32 ± 1.29 (12.45–15.95) mg/m² per day, P = 0.22. Hypertension was identified in 24.1% of CAH patients (7 SW and 1 SV) and 13.8% (n = 4) of controls (P < 0.0001). Impaired glucose tolerance was found in 2 CAH patients (13.3 and 30.1 years-old). In the CAH group, significant association was found between HOMA-IR and visceral adipose tissue in grams (r = 0.636, P = 0.011) and HOMA-IR and waist-to-hip-ratio (r = 0.543, P = 0.045). HC dose was not related to BMI, TBF, BP or HOMA-IR.

Conclusions: CAH patients had higher BMI, TBF and frequency of hypertension compared to controls. Doses of glucocorticoids were not associated with body composition and BP in CAH patients.