ESPE Abstracts

Background: Non-classical congenital adrenal hyperplasia (NCCAH) is a hyperandrogenic disorder affecting negatively the psychological health and the quality of life (QoL) of patients.

Aim: To evaluate the psychological health and QoL in female NCCAH patients in comparison to female age-matched healthy controls.

Participants and Methods: A total of sixty-eight females, aged 10-27 years, were enrolled in this study, including thirty-four patients with NCCAH (mean age 16.2±3.4 years) and thirty-four healthy controls (mean age 15.0±3.1 years). Data was collected on anthropometry, clinical features of hyperandrogenism (hirsutism, acne, hair loss) and menstrual irregularities. Hormonal and metabolic markers were assessed. A validated World Health Organization (WHO) Brief quality-of-life questionnaire-26 was used for the assessment of physical (D1) and psychological (D2) health, social relationships (D3) and environment (D4). Psychological assessment was evaluated using the EDI-3 standardized questionnaire.

Results: Hirsutism and acne were more common in NCCAH girls compared to healthy controls (80.5% vs. 19.5%, P<0.0001 and 80% vs. 20%, P<0.001, respectively). No significant difference was found in the rate of menstrual disorders between groups. The estimated mean Ferriman-Gallwey score was higher in NCCAH girls (18.7±5.3 vs 7.7±8.3, P<0.001) being correlated with Androstendione and 17OHProgesterone levels (r= 0.519, P<0.001 and r= 0.424, P<0.001, respectively). Overweight/obesity presence was determined in 17.7% of all participants without a significant difference between the groups. Androstendione (15.4±6.7 vs. 9.8±5.3, P<0.001) and basal levels of 17OHProgesterone (2.2 ±1.3 vs. 0.8±0.6, P<0.001) were significantly higher in NCCAH females. Androstendione levels correlated with the presence of acne (r= 0.369, P=0.002), hair loss (r= 0.370, P=0.002) and hirsutism (r= 0.289, P=0.017). 17OHProgesterone basal levels correlated with hirsutism (r= 0.450, P<0.001), acne (r= 0.491, P<0.001) and psychological health (r= 0.355, P=0.003). Analyzing the WHOBrief QoL questionnaire the NCCAH girls showed significantly lower physical and psychological health scores compared to healthy females (50.5±11 vs. 62.9±11.5 for D1, 57.6±11.5 vs. 68.7±10.5 for D2, P<0.001). The psychological status correlated negatively with the presence of hirsutism (r= -0.306 P=0.012), acne (r= -0.333, P=0.006) and hair loss (r= -0.333, P=0.006). The EDI-3 survey showed that NCCAH patients had significantly low assessment score results on 8 of all used psychological scales compared to controls - interpersonal alienation, interoceptive deficits, emotional dysregulation, low self-esteem, affective problems composite, general psychological maladjustment, ineffectiveness and overcontrol (P<0.05 for all).

Conclusion: The hyperandrogenic NCCAH girls have impaired QoL and psychological health. Therefore, early diagnosis and management are important for the prevention of psychological consequences.