ECE2021 Audio Eposter Presentations Adrenal and Cardiovascular Endocrinology (80 abstracts)
Patients with congenital adrenal hyperplasia show an adverse cardiovascular risk profile compared to patients with autoimmune adrenalitis
Hannes Beiglböck , Magdalena Bögl , Paul Fellinger , Matthaeus Metz , Greisa Vila , Anton Luger , Siegfried Trattnig , Alexandra Kautzky-Willer , Martin Krssak , Michael Krebs & Peter Wolf
Medical University of Vienna, Internal Medicine 3, Endocrinology and Metabolism, Vienna, Austria
Background
Despite adequate hormone replacement therapy, evidence suggests an increased mortality in patients suffering from primary adrenal insufficiency, mainly because of cardiovascular diseases. Congenital adrenal hyperplasia (CAH) and autoimmune adrenalitis (AI) are two entities with a different pathophysiological background and might therefore show divergent cardiovascular risk profiles.
Methods
9 patients with CAH (female n = 4; age: 39 ± 11years; weight: 71 ± 12 kg; equivalent dose of hydrocortisone:19 ± 7 mg/day) and 9 patients with AI (female n = 4; age: 43 ± 9years; weight: 73 ± 15 kg; equivalent dose of hydrocortisone: 24 ± 7 mg/day) under stable glucocorticoid substitution therapy were investigated. Fasting blood was drawn to evaluate glucose- and lipid metabolism. Standardized blood pressure measurements and magnetic resonance imaging and spectroscopy measurements were performed to assess cardiac function, myocardial (MYCL) & hepatic lipid content (HCL) and abdominal fat mass.
Results
Fasting glucose (91 ± 10 vs 80 ± 7 mg/dl; P = 0.021), HbA1c (5.44 ± 0.3 vs 5.1 ± 0.4%; P = 0.044) and blood pressure (124 ± 8/80 ± 6 vs 113 ± 10/71 ± 6; P = 0.031) were higher in CAH compared to AI. This was paralleled by an increase in HCL (5.8 ± 5 vs 1.8 ± 1%; P = 0.0549) and abdominal fat mass (251 ± 130 vs 378 ± 119 mm2; P = 0.047). No differences in heart function (Ejection fraction: 56 ± 4 vs 59 ± 8%; P = n.s) and MYCL (0.28 ± 0.2 vs 0.25 ± 0.1%; P = n.s.) were observed. Patients with CAH were treated more frequently by evening doses of glucocorticoids (6/9 vs 1/9) or others than hydrocortisone (5/9 vs 0/9).
Conclusions
CAH is associated with an adverse cardiovascular risk profile compared to AI, despite a comparable dose of daily glucocorticoid substitution. This might be explained by a more unphysiological timing of replacement therapy or the more frequent use of longer-acting glucocorticoids in patients with CAH, as well as by the adverse metabolic effects of hyperandrogenemia in women.
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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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