Background: Recent studies suggest patients with congenital adrenal hyperplasia (CAH) have adverse cardiovascular risk profile and other long-term health problems in adult life. However, there are limited data of these comorbidities in paediatric CAH patients.
Objective and hypotheses: To evaluate the cardio-metabolic risk factors in children and adolescents with classical 21-hydroxylase deficiency (21-OHD) compared with age, sex and puberty-matched healthy controls.
Method: A cross-sectional study of 21 Thai patients (females, n=17) with CAH aged 15.2±5.8 years and 21 healthy matched controls. Anthropometric, biochemical and inflammatory markers were measured. Bone mineral density (BMD), fat mass and lean mass were measured using dual-energy x-ray absorptiometry (DXA).
Results: Obesity was observed in 33% of the patients (7/21). The waist/hip ratio and waist/height ratio were significant higher in CAH patients when compared with controls. Three patients (14%) of 21 patients were noted to have prehypertension and two patients (9.5%) had hypertension. Fasting blood glucose levels in CAH patients were lower than normal subjects but HOMA-IR was not different. There were no significant correlations between HOMA-IR and glucocorticoid dose, age or 17-hydroxyprogesterone levels. Silent diabetes and metabolic syndrome were diagnosed in one patient (4.8%), but none in the control group. Lipid profiles were not different between patients and healthy controls except lower HDL to cholesterol ratio in CAH patients than in normal subjects. CAH patients had significantly higher AST levels than controls. Serum leptin concentrations were not different between groups, and positively correlated with BMI and HOMA-IR. Interleukin-6 levels in CAH patients did not differ from controls, but hs-CRP levels tended to be higher in patients compared with controls. No significant differences in BMD z-score, fat mass and lean mass were found between CAH and healthy subjects.
Conclusion: Children and adolescents with CAH appear to have an increased risk of obesity and cardio-metabolic risk factors. Close monitoring, early identification, and secondary prevention should be implemented during paediatric care to prevent metabolic complications and improve the long-term health outcomes in CAH patients.
Funding: This work was supported by the Ratchadapiseksompotch Fund, Faculty of Medicine, Chulalongkorn University and the Thailand Research Fund.