ESPE Abstracts (2019) 92 P1-160

Serum fetuin-A and insulin levels in classic congenital adrenal hyperplasia

Erdal Kurnaz1, Şemra Çetinkaya1, Servan Özalkak1, Elvan Bayramoglu1, Gülşah Demirci2, Hasan Serdar Öztürk2, Şenay Savaş Erdeve1, Zehra Aycan1


1Dr. Sami Ulus Obstetrics and Gynecology and Pediatrics Training and Research Hospital, Pediatric Endocrinology Clinic, Ankara, Turkey. 2Department of Medical Biochemistry, Ankara University Medical Faculty, Ankara, Turkey


Background: Androgens play a pivotal role in non-reproductive tissues, such as the kidney, heart, and liver, as well as the pancreas. Since the androgen receptor is expressed in pancreas and liver cells, this raises the possibility that excess testosterone results in insulin hypersecretion, and in fetuin-A, a protein produced in the liver. However, whether fetuin-A and insulin levels are affected by androgens in classic congenital adrenal hyperplasia (CAH) due to excess androgen exposure is unknown.

Methods: This research was designed as a cross-sectional study, and included 56 CAH subjects and matched controls. Measurements were performed on the basis of gender and of prepubertal/pubertal status to eliminate potential changes in serum metabolic/inflammatory markers associated with the production of sex steroids. CAH subjects and controls were then examined according to their clinical characteristics.

Results: Insulin and fetuin-A levels were significantly higher in the CAH patients than in the controls. Those unfavorable levels exhibited positive correlation with androgens, such as total and free testosterone. Multiple regression analysis revealed that total testosterone levels predicted fetuin-A and insulin levels in CAH patients (r2=0.39, P<0.001; r2=0.36, P=0.027). Differences were also observed in triglycerides and high-sensitivity C-reactive protein between the pubertal and prepubertal groups, respectively.

Conclusions: Serum fetuin-A and insulin levels are associated with androgens in CAH patients. It can be considered that androgens have indirect and direct effect on regulation of insulin.

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