ESPE2015 Poster Category 2 Adrenals (38 abstracts)
Evaluation of Medical Treatment in the First 2 Years of Life with a New Dutch National Longitudinal Registry for Children with Congenital Adrenal Hyperplasia (CAH)
Annelieke van der Linde a , Erica van den Akker f , Willy Bakker- van Waarde e , Sabine Hannema j, , Gea Hoorweg-Nijman k , Hetty van de Kamp c , Daniel Klink g , Roelof Odink h , Saartje Straetemans i , Paul van Trotsenburg d , Paul Verkerk b & Hedi Claahsen-van der Grinten a
aRadboudumc, Nijmegen, The Netherlands; bTNO, Zeist, The Netherlands; cUMC Utrecht, Utrecht, The Netherlands; dAMC, Amsterdam, The Netherlands; eUMCG, Groningen, The Netherlands; fErasmusmc, Rotterdam, The Netherlands; gVUmc, Amsterdam, The Netherlands; hCatharina Hospital Eindhoven, Eindhoven, The Netherlands; iMUMC, Maastricht, The Netherlands; jLUMC, Leiden, The Netherlands; kSt Antonius Hospital, Nieuwegein, The Netherlands
Background: Recently, a national database has been developed to register yearly data from all children detected with CAH in the neonatal screening program from 2002 onwards. So far longitudinal data of 105 children have been registered (roughly 65% of Dutch CAH patients) to evaluate medical treatment and long-term effects in CAH. A national CAH work group developed guidelines for diagnostics and follow up in CAH.
Objective and hypotheses: Aim of our current study is to evaluate the dosage of hydrocortisone, fludrocortisones and salt supplementation in CAH children in the first 2years of life.
Method: This is a descriptive study in 105 children. The hydrocortisone, fludrococrtisone and salt medication was evaluated at the age of six months (T 0.5), 12 months (T1) and 24 months (T2). The treatment approaches of different centers was compared.
Results: T 0.5: (n=95): median HC dosage (n=89) 4 mg/day. Interquartile range (IQR) 2 mg/day. FC (n=82) median 93.75 mcg/day; IQR 37.5 mcg/day and NaCl (n=46) median 500 mg; IQR 400 mg/day. T 1: (n=90) median HC dosage (n=88) 4 mg/day; IQR 1 mg/day, FC (n=84) median 62.5 mcg/day; IQR 30.3 mcg/day and NaCl (n=25) median 375 mg/day; IQR 400 mg/day. T2: (n=88) median HC dosage (n=84) 5.4 mg/day; IQR 2.14 mg/day, FC (n=78) median 62.5 mcg/day; IQR 37.5 mcg/day. No salt medication was used after the first year of life. No significant differences between centers are observed.
Conclusion: Our analysis showed a stable slightly supraphysiological HC dosage over the first 2 years of life. FC shows a more widespread range in dosage suggesting a more individualized treatment approach without a clear difference between national centres. Further studies will focus on the relation between medication dosage and biometrical data. Our longitudinal database gives the opportunity to establish a more standardized care and long-term treatment evaluation.
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