ESPE Abstracts

Background: While the risk for hypoglycemia during acute illness is well described in children with classical congenital adrenal hyperplasia (CAH), there is little evidence for the prevalence of asymptomatic hypoglycemia in CAH. We explored the glucose profile of children with classical CAH by the use of continuous glucose monitoring (CGM).

Methods: We conducted an observational study in children aged 1-6 years with a diagnosis of classical CAH receiving hydrocortisone and fludrocortisone replacement therapy. Participants underwent two 14-days continuous glucose monitoring (CGM) sessions. Data were analyzed according to three day-time lags (7am-4pm; 4pm-10pm; 10pm-7am) that corresponds to the timing of assumption of the hydrocortisone dose.

Results: Eleven participants (3.01.8 y) completed at least one CGM session. Hydrocortisone mean dose was 13.7mg/m2/d (12.4, 15) in the CGM cohort with three daily administration and a daily percentage distribution of the dose of 35%-30%-35% among the three assumptions (7am, 4pm, 10pm). Morning plasma Delta-4-Androsenedione, testosterone were measured at the enrolment and resulted suppressed (<0.26nmol/L and <0.13nmol/L, respectively) with 17-OH progesterone meeting the therapeutic target (0.48nmol/L[0.43,3.65]). We analyzed 20.6 patient-days from the whole CGM cohort for a total of 226 days of monitoring. The percentage of time of sensor glucose values <70mg/dL was higher during the 10pm-7am and the 7am-4pm time slots than in the late afternoon period [17% [7,54] and 15%[6.8,24] vs 2%[1.1,16.7] during the periods 7am-4pm and 4pm-10pm respectively (P=0.006 and P=0.003)].

Conclusion: CGM demonstrated a disrupted daily glucose pattern in children with CAH. Children without CAH in the same age group displays less than 1% of sensor glucose readings <70mg/dL in the absence of values lower than 54mg/dL. As a contrary, herein we observed that both during nighttime and morning/early afternoon, children with CAH spend ~15% of the time at a glucose value lower than 70mg/dL in sharp contrast with what observed in the late afternoon and in their healthy peers whose time in mild hypoglycemia in about 6 minutes per day.