Endocrine Abstracts

Background: The cardiovascular and metabolic outcomes of patients with AI are poor, and may be related to the non-physiological cortisol profile achieved with hydrocortisone treatment.

Objectives: To describe salivary adrenal biomarkers, glucose and 24 hour ambulatory blood pressure (ABP) profiles, carotid intima media thickness (CIMT) and flow mediated dilatation (FMD) in CYP with primary AI, to improve knowledge of the relationship between non-physiological cortisol exposure, glucose regulation, metabolic and cardiovascular disease. Here we present preliminary data on cardiovascular and glucose parameters.

Methods: CYP, aged 2-18 years were recruited. ABP (24 h, age >10 years only), vascular ultrasound (age >4 years only) and continuous glucose monitoring (CGM) with blinded Dexcom G6 monitor (seven days) were performed.

Results: Twenty-two children (11 male, age 9.1 ± 4.9 years: three Addison’s Disease, 19 congenital adrenal hyperplasia,) were recruited. Height was -0.05±1.16SD and BMI +0.77±1.20SD. Hydrocortisone dose was 10.5±3.5 mg/m²/day. 16 patients (73%) were treated with fludrocortisone, 125±56 micrograms.

CGM data are given in Table 1. One patient did not tolerate CGM.

In six patients (28.6%) glucose was >10 mmol/l for 0.4-2.8% of the time, and in five patients (28.6%) <3 mmol/l for 0.2-2.4% of the time. CIMT (N=17) measured 0.41mm ± 0.04mm (median, IQR), within expected limits. FMD (N=15) measured 8.06 ±7.9% (median, IQR). FMD was lower than expected for the paediatric population in six patients (11%). ABP was achieved in 11 patients, of whom one was hypertensive.

Conclusion: These preliminary data suggest the glucose profile of CYP with primary AI differs to that of healthy children. FMD may detect early signs of cardiovascular disease, and longitudinal studies are required to ascertain the clinical significance of this observation.