ESPE Abstracts

Introduction: Management of CAH presents unique challenges distinct from other forms of adrenal insufficiency. Higher doses of glucocorticoids are required to suppress adrenal androgen synthesis, which can lead to overtreatment. Steroid-associated adverse events (SAAE) include hypertension, hyperglycemia, and diabetes, overweight and obesity and short stature.

Aim: The goal of this study was to assess the occurrence of steroid-associated growth and metabolic adverse events (SAAE) in children with CAH on treatment with CS since early infancy and to compare them with another high-risk group (obese children BMISDS > 2).

Methods: Data of 30 children with CAH was analysed retrospectively. They received hydrocortisone (n= 11) or prednisolone (n= 19) and fludrocortisone (0.1: 0.15 mg OD) since early infancy. The mean hydrocortisone dose = 22.5 +/- 7 mg/m2. The growth data was recorded and the different metabolic criteria including impaired fasting glucose (IFG), high LDL and cholesterol, lower HD and high blood pressure for age and sex were studied over this period and compared with the data for 66 age-matched obese non-nephrotic children.

Results: Comparison between the CAH group treated for an average of 5 years with CS and age matched obese children showed that short stature (HtSDS < -2) and high LDL occurred more significantly the CAH group. Impaired fasting glucose and low HDL occurred more in the obese group. Hypertension was detected in 2/30 (6.7%) of the CAH group vs 12.1% in the obese group. (Table 1)

Conclusion: Children with classic CAH on CS treatment for > 5 years had high rate of obesity and overweight (60%0 and short stature (23.3%). In addition, some of them have higher occurrence of metabolic criteria including high LDL and triglyceride and blood pressure. These patients shall be monitored closely for abnormal growth (weight and height) as well as for abnormal metabolic criteria.