Assessment of blood pressure and carotid intima media thickness (CIMT) in children with primary adrenal insufficiency

Julie Park; Helen Shantsila; Daniel Hawcutt; Gregory Lip; Joanne Blair

Background: Increased risk of cardiovascular disease and increased subclinical atherosclerosis have been reported in children with primary adrenal insufficiency (AI), including those with congenital adrenal hyperplasia (CAH), when compared to healthy children. Carotid intima media thickness (CIMT) can be used as an early marker of cardiovascular risk. The severity of adverse metabolic profile has been related to the total hydrocortisone dose and duration of treatment.

Aim: To assess the prevalence of increased CIMT, an early marker of cardiovascular risk, in children with primary AI.

Methods: Children with primary AI treated with hydrocortisone had CIMT measurements performed using ultrasonography. Measurements were taken approximately 0.5mm distal from the carotid bulb on their right carotid artery. Average measurements were taken from three images. Two sitting blood pressure measurements were taken from the left arm and an average was ascertained.

Results: Measurements were performed on 17 children (9 male), aged 9.9 ± 4.1 years. Diagnoses were Addison’s (n = 3) and CAH (n = 14, of whom 9 had salt wasting CAH). 2 children, aged 5 and 7 years, could not tolerate the procedure. Median CIMT measured 0.41mm (range 0.40-0.48). Two children had a systolic blood pressure of >95^th centile. One child had a diastolic blood pressure >95^th centile. Children with blood pressure readings >95^th centile were on hydrocortisone doses of 5.6-10.8 mg/m²/day and fludrocortisone doses between 0-175 micrograms/day. Linear regression analysis, adjusted for age, length of time since diagnosis/start of hydrocortisone treatment and dose of hydrocortisone taken did not show an association with CIMT values.

Table 1 Demographics and clinical characteristics
	Mean ± SD
Height SDS	0.81 ± 1.34
BMI SDS	0.13 ± 1.21
Length of time since diagnosis (years)	6.06 ± 4.05
Hydrocortisone dose (mg/m²/day)	10.8 ± 3.93
Systolic blood pressure centile (percentile)	75.6 ± 34.2
Diastolic blood pressure centile (percentile)	59.0 ± 25.3
*SDS = standard deviation score

Conclusion: These preliminary data show CIMT measurements that are within the normal range, in this cohort of children with primary AI. Contrary to historical data, early subclinical atherosclerotic changes have not been identified. This may reflect good clinical practice. Hydrocortisone doses are reviewed and adjusted regularly, guided by both clinical and biochemical parameters.

ESPE Abstracts

P2-35