ESPE Abstracts (2016) 86 RFC1.6

Pediatric Patients with Congenital Adrenal Hyperplasia have Unfavorable Changes in their Cardiovascular Risk Profile

Christiaan F. Mooija, Antonius E. van Herwaardenb, Nel Roelevelda,c, Chris L. de Korted, Livia Kapustae,f & Hedi L. Claahsen - van der Grintena


aDivision of Pediatric Endocrinology, Department of Pediatrics, Amalia Children’s Hospital, Radboud University Medical Center, Nijmegen, The Netherlands; bDepartment of Laboratory Medicine, Radboud University Medical Center, Nijmegen, The Netherlands; cDepartment for Health Evidence, Radboud University Medical Center, Nijmegen, The Netherlands; dMedical Ultrasound Imaging Center, Department of Radiology, Radboud University Medical Center, Nijmegen, The Netherlands; ePediatric Cardiology Unit, Dana-Dwek Children’s Hospital, Sourasky Medical Center, Tel Aviv University, Tel Aviv, Israel; fChildren’s Heart Center, Amalia Children’s Hospital, Radboud University Medical Center, Nijmegen, The Netherlands


Background: Patients with congenital adrenal hyperplasia (CAH) are at risk of developing an unfavorable cardiovascular risk (CVR) profile. Data on the CVR profile in pediatric CAH patients are scarce.

Objective and hypotheses: To evaluate the CVR profile of pediatric CAH patients.

Method: A cross-sectional study in CAH patients (8–16 years) was performed (n=27). Blood was taken to evaluate several circulating CVR markers. Insulin resistance (IR) was evaluated by HOMA-IR. Blood pressure (BP) was evaluated by office BP measurements and 24 hour ambulatory BP measurements (24 h ABPM). Carotid intima media thickness (cIMT) was evaluated. In patients >12 years a DXA scan was performed. SD scores (SDS) were calculated if possible.

Results: BMI SDS was significantly elevated (0.67; P=0.012) with 7 patients being overweight (25.9%) and 4 obese (14.8%). BMI SDS was associated with 17OHP (r=0.394; P=0.042) and androstenedione (r=0.406; P=0.036) concentrations, but not with hydrocortisone (HC) dose. DXA scan evaluation of body composition showed fat tissue mass SDS of 0.94 (P=0.043) and percentage body fat SDS of 1.59 (P<0.001). Body composition and HC dose were not associated. Office systolic and diastolic BP SDS were both higher than reference values (0.83, P<0.001; 0.56, P<0.01). The 24 h ABPM showed systolic hypertension in 5 patients (18.5%), while 11 patients (40.7%) had a non-dipping BP profile. The percentage of the dip in sleeping BP was negatively associated with BMI SDS (r=−0.489; P=0.01), but not with daily HC dose. HOMA-IR was above the 75th percentile in 12 patients (44.4%) and was positively associated with daily HC dose (r=0.436, P=0.023) and BMI-SDS (r=0.500, P=0.008). The lipid profile and cIMT were normal.

Conclusion: CAH patients may develop an unfavorable CVR profile already in childhood with significantly increased BMI, increased fat mass, elevated BP levels, a non-dipping BP profile, and IR. BP levels, the percentage dip in sleeping BP, HOMA-IR values were associated with BMI SDS.

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