ESPE Abstracts

Objective: To summarize the metabolic status in children with classic congenital adrenal hyperplasia(CAH) due to 21-hydroxylase deficiency (21OHD).

Methods: Children with classic 21OHD from Pediatric Endocrinology Clinics at the First affiliated hospital of Sun Yat-Sen University from January 1990 to February 2023 were included in the study. The prevalence of overweight/obesity, dyslipidemia [high triglyceride (TG), high cholesterol (TC), low high-density lipoprotein cholesterol (HDL), high non-high-density lipoprotein cholesterol (nHDL), high and low density lipoprotein cholesterol (LDL)], and abnormal glucose metabolism [hyperglycemia, hyperinsulinemia and insulin resistance] were investigated.

Results: (1) BMI: A total of 379 children were included. Overweight/obesity was observed in 50.40% and obesity in 25.07% of the children at 1 or more visits, with higher prevalence in SW form than SV form(57.92% vs 43.37%) (P=0.005). The prevalence of obesity increased significantly from the age of 4 and peaked at the age of 8(5.49% -25.58%). (2) Dyslipidemia: A total of 291 children were included, 64.60% of whom were found with dyslipidemia at 1 or more visits, with the rank (from high to low) was high TG (36.08%), high TC (31.27%), low HDL (30.93%), high nHDL (29.21%) and high LDL(25.43%). Overweight/obesity was a risk factor for high TG (OR: 1.992, 95%CI: 1.210, 3.280) and low HDL (OR: 1.802, 95%CI: 1.057, 3.075). (3) Abnormal glucose metabolism: A total of 379 children were included. The prevalence of fasting hyperglycemia, hyperinsulinemia and insulin resistance was 1.32%, 21.40% and 21.03%, respectively. Overweight/obesity (OR: 7.083, 95%CI: 3.417, 14.683) and dose of hydrocortisone of 15-17mg/m2/d (OR: 5.351, 95%CI: 2.592, 11.047) were the risk factors for hyperinsulinemia, while male (OR: 0.437, 95%CI: 0.217, 0.881) was protective against hyperinsulinemia. For insulin resistance, the risk factors were obesity/overweight (OR: 5,870, 95%CI: 2.902, 11.872) and relatively high-dose hydrocortisone 15-17mg/m2/d (OR: 5.136, 95%CI: 2.518, 10.478). The prevalence of hyperinsulinemia and insulin resistance was parallel with age, peak at the age of 13 (38.71% and 35.48%, respectively).

Conclusion: Children with CAH 21OHD had high risk of metabolic disorders increasing with ages. Higher incidence of hyperinsulinemia was found in female. Obesity/overweight was a risk factor for dyslipidemia, insulin resistance and hyperinsulinemia. Dose of relatively higher dose of hydrocortisone 15-17 mg/m2/d was a risk factor for insulin resistance and hyperinsulinemia.