ESPE Abstracts

Congenital adrenal hyperplasia (CAH) due to 21-hydroxylase(21-OH) deficiency is the most common type of CAH. In the treatment, the insufficinet hormones are replaced. The excess doses cause hypercortisolism, insufficient doses; causes hyperandrogenism. Both metabolic conditions; It has been found to be associated with comorbidities that increase the risk of cardiovascular disease. Here, it is aimed to determine the comorbidities that increase the risk of cardiovascular disease and the presence of metabolic syndrome(MS) in cases of 21-OH deficiency to investigate the pathophysiological roles of some inflammatory cytokines and midkine levels.

Material&Methods: The cases followed up with a diagnosis of CAH due to 21-OH deficiency and healthy controls in the study. The study was supported by Turkish Society for Pediatric Endocrinology and Diabetes. Ethics committee approval was obtained. The cases were grouped according to CAH type-metabolic control status-high sensitivity CRP levels. World Health Organization MS diagnostic criteria were used for MS. During the routine controls of the cases, additional blood samples were taken together with metabolic control tests and IL-1,2,10,4,17,22, TNFα, midkine levels were studied. The results; it was evaluated statistically according to gender-puberty/dyslipidemia/insulin resistance/hypertension/MS presence-inflammation risk conditions.

Results: The study included 55cases diagnosed with classical CAH(n:20 girls), with a mean age of 10.94±4.26years, 24healthy cases with a mean age of 9.98±2.43years.31 of the cases(56%) were salt-wasting type, 24cases were(44%) were simple virilizing type CAH. The average disease duration was 10.03±4.34years, average age at diagnosis was 0.89±1.66years, average glucocorticoid&mineralocorticoid treatment doses were 19.02±11.43 mg/m2/day&0.049±0.019 mg/day. 54%(n:30) of the cases were pubertal, 43%(n:24) were in good metabolic control, 43%(n:24) were obese, 36%(n: 24) were dyslipidemia, 54%(n:30) have low risk of inflammation, 10%(n:6) have hypertension, 20%(n:11) have MS. Metabolic control was poor in 60% of the patients with MS. Some cytokine levels and midkine levels belonging to inflammatory&anti-inflammatory&regulatory cytokine groups in the cases; It was found to be similar according to gender-CAH type-pubertal status-dyslipidemia/insulin resistance-presence-metabolic control status. IL2 levels were found to be lower in the MS group. In the group with high inflammation risk, compared to the group with low risk; IL-1B,4,10, midkine levels were found to be low.A strong positive correlation was found between midkine levels and IL-1B,10,17,4,22 levels in all groups. In our study, we found that there were no changes significant levels in the cytokines and midkine. We predict that intrauterine hyperandrogenism may have protective effects against systemic inflammation in CAH patients.