Endocrine Abstracts

Introduction: There are data reporting an increased risk of cardiovascular and metabolic complications in patients with NCAH. This is frequently attributed to glucocorticoid (over)use. It seems that long-term exposure to increased androgens concentration may also itself lead to diminished insulin sensitivity and increased risk of prediabetes and diabetes.

Aim: The aim of the study was to assess the link between NCAH diagnosis and glucose metabolism disturbances.

Material and methods: The study included 327 subjects (315 females and 12 males, median age 25 years) referred for a cosyntropin stimulation test due to the suspected NCAH. Serum 17-OH-progesterone (17-OHP) was measured with ELISA assay. The diagnosis of NCAH was confirmed if the initial or stimulated 17-OHP concentration exceeded 10.0 ng/ml. None of the tested subjects was treated with glucocorticoids. The Mann-Whitney U and Yates’ χ2 tests were used in statistical analyses, with P<0.05 as cut-off value of statistical significance.

Results: 62 patients (60 females, 2 males; median age 26 years) were diagnosed with NCAH, the rest of tested subjects were considered the control group. Type 2 diabetes was diagnosed earlier in 10 subjects in the entire study group (6 of them were diagnosed with NCAH). There was no significant difference in the fasting glucose levels (P=0.08) and BMI (P=0.32) between subjects with and without NCAH diagnosis (median fasting glucose: 4.96 mmol/l and 4.86 mmol/l, respectively; median BMI: 23.82 kg/m² and 23.26 kg/m², respectively). Diabetes was significantly more frequent in patients with NCAH diagnosis (P=0.004; power: 0.74). The median 17-OHP was higher in patients with diabetes compared to those without it at both 30 (12.25 ng/ml vs 3.25 ng/ml; P=0.003) and 60 minutes (14.93 ng/ml vs 3.95 ng/ml; P=0.046) after stimulation.

Conclusions: NCAH seems to be linked to increased diabetes risk, even before glucocorticoid treatment is initiated. It seems advisable to screen NCAH patients for glucose metabolism disorders.