ESPE Abstracts

Background: Children with congenital adrenal hyperplasia (CAH) may suffer from multiple psychological troubles.

Objective and hypotheses: To assess the psychological and behavioral outcome of genetically females with classic CAH and to study the extent to which these behavioral changes could be attributed to high levels of androgens in the prenatal and postnatal periods.

Method: 51 genetically females with CAH, representing Prader stages II–V at birth, aged 12±4.7 years. Simple virilizing (SV) was 47% and salt-wasting (SW) was 53% of patients. Nine cases were assigned female, and eight cases were named as males after birth. Psychiatric history and examination were recorded, in addition to the Wechsler Intelligence Scale for children. The anxiety, depression, self-concept scales and the behavioral checklist for children were applied.

Results: Significant degree of depression score was reported in 21 patients (41.2%), anxiety in 39 patients (76.5%), anxiety/depression in 18 cases (35.3%), low self-concept in 30 (58.8%). In addition, 48 cases were withdrawn (94.1%) and 15 experienced sex problems (29.4%). Regarding prenatal androgen exposure, depression and anxiety were correlated with CAH type (SW or SV) (P=0.03, r=0.4 and P=0.02, r=0.2). Significant positive correlation of genital masculinization at diagnosis associated with self-concept (P=0.002, r=0.476). Depression was greater in females with SW-CAH than in females with SV-CAH (P=0.04). Patients had low early postnatal levels of androgen not associated with altered psychology and/or behaviour. Depression, anxiety, aggression, and sex problems were not associated with bone age advance as an indicator of growth advancement and late androgen excess. ((r(P): −0.227(0.195), −0.29(0.13), −0.02(0.45), 0.26(0.15) respectively), except for the association with self-concept (r=0.48, P=0.02*).

Conclusion: Behavioral disturbances in girls with CAH result from high levels of androgens during fetal development and rather than postnatal life.