ESPE Abstracts

Context: Non-classic congenital adrenal hyperplasia (NCCAH) diagnosed in childhood, whether treated or untreated, could pose an increased risk of obesity and metabolic derangements in adolescence and early adulthood. Both sustained hyperandrogenism and chronic glucocorticoid therapy may affect body composition. However, little is known about the body composition of subjects with NCCAH and its contribution to the development of adverse metabolic outcomes.

Aim: To explore the interaction between muscle-to-fat ratio (MFR) and metabolic syndrome components in pediatric subjects with NCCAH.

Methods: This retrospective, observational study was conducted in a tertiary center. The study group comprised 75 subjects with NCCAH (26 males [61 hydrocortisone-treated and 14 untreated]) and 50 subjects with premature adrenarche (PA, 8 males). The control group comprised 134 healthy sex- and age-matched subjects (41 males) with normal puberty landmarks. Body composition was measured by bioelectrical impedance analysis (BIA, Tanita MC-780 MA and GMON Professional Software), and MFR z-scores were calculated. Stepwise linear regression models were applied to evaluate explanatory variables for MFR z-scores, blood pressure percentiles, lipid profiles and glucose metabolism. Variables entered into the models included: sex, socioeconomic position (SEP) index, family history of obesity, age (at diagnosis and BIA), perinatal characteristics (gestational age, birthweight z-scores), hydrocortisone exposure (mean dose, treatment duration, cumulative dose) and MFR z-scores (for metabolic syndrome components).

Results: The median age [interquartile range] was 7.5 years [5.3, 8.8] at NCCAH diagnosis, and 12.3 years [8.9, 15.4] at BIA. The median cumulative hydrocortisone dose was 7620 mg/m² [2547, 12903]. Subjects with NCCAH had higher mean BMI z-scores compared to controls (0.47±0.97 vs. -0.19±1.04, P<0.001) and lower median MFR z-scores (-0.74 [-1.06, -0.14] vs. -0.37 [-0.99, 0.15], P=0.045), with no significant differences between NCCAH and PA groups. Linear regression models and their explanatory variables: MFR z-score (r²=0.253, P<0.001) - SEP index (B=0.348, P=0.003), birthweight z-score (B=-0.258, P=0.013) and duration of hydrocortisone treatment in years (B=0.048, P=0.023); systolic BP percentile (r²=0.166, P<0.001) - MFR z-score (B=-9.75, P<0.001); TG/HDL ratio (r²=0.116, P=0.024) - MFR z-score (B=-0.300, P=0.024); no significant variables were found for glucose.

Conclusions: Our findings suggest that youth with NCCAH have a body composition characterized by an imbalance between muscle and fat tissue, placing them at increased risk for early-onset cardiometabolic derangements. It is reassuring that glucocorticoid therapy in pediatric patients with NCCAH aimed to alleviate androgen overproduction does not appear to adversely affect body composition.