ESPE Abstracts

Background: Congenital adrenal hyperplasia (CAH) is a rare form of adrenal insufficiency characterized by impaired cortisol synthesis leading to excessive adrenal androgen production. Little is known regarding the effects of early and chronic androgen exposure in children with CAH, and whether this exposure may increase the risk of developing attention-deficit/hyperactivity disorder (ADHD) during childhood. The only study on the subject, based on a small sample of children and adolescents with CAH (n=54), reported an increased rate of ADHD. The objective of the current study was to investigate the prevalence of ADHD in large administrative samples of insured children and adolescents with CAH compared to the general pediatric population in the United States.

Methods: We used the Treatment Pathways® interface to analyze data for individuals enrolled in employer-sponsored or public insurance plans with inclusion of pharmacy and mental health services claims in the IBM® MarketScan® Commercial and Medicaid Claims Databases. Subjects were included if they were continuously enrolled for ≥12 months from the first outpatient claim during October 2015-December 2017 and were between the ages of 5 and 18 years at that time. CAH prevalence was measured as the percentage of children and adolescents with ≥2 claims with E25.0 ICD-10 codes for CAH and ≥2 glucocorticoid prescriptions filled during the study period. ADHD prevalence was ascertained using a published claims-based algorithm. Subjects were stratified by age (5-11 years vs 12-18 years).

Results: The study period prevalence of CAH in the Commercial (N=3,532,914) and Medicaid (N=2,766,297) samples was 1/9,500 (n=373) and 1/14,000 (n=201), respectively. The prevalence of ADHD in the general population was 7.7% in the Commercial sample and 15.1% in the Medicaid sample. Among children and adolescents with CAH, there was no increase in risk of ADHD in either the Commercial (7.8% (n=29), odds ratio (OR)=1.01, 95% confidence interval (CI): 0.68-1.45, P=0.95) or Medicaid (13.9% (n=28), OR=0.91, 95% CI: 0.60-1.34, P=0.65) samples, as compared to the general population. ADHD prevalence did not differ significantly by age among those with CAH in either the Commercial or Medicaid samples.

Conclusions: Using two large national samples of privately and publicly insured children and adolescents with CAH in the United States, we found that the prevalence of medically-managed ADHD was comparable to that of the general pediatric population. These findings suggest that enhanced screening for ADHD among the pediatric CAH population may not be warranted.