ESPE Abstracts

Background: Hypertension is a recognized complication in children with Congenital Adrenal Hyperplasia (CAH) due to 21-hydroxylase deficiency, treated with glucocorticoids and mineralocorticoids. This study aims to compare the clinical and laboratory characteristics of children with CAH who developed hypertension with those who maintained normal blood pressure (BP) over a treatment course.

Methods: This retrospective cohort study included children with CAH who were followed up for a mean duration of 7 ± 3 years. We compared two groups: normotensive (n = 73) and hypertensive (n = 16) patients. Data collected included age, compliance to treatment, anthropometric measures (Weight SD, Height SD, BMI), bone age standard deviation (SD), hydrocortisone dose, and serum levels of 17-hydroxyprogesterone (17OHP) and adrenocorticotropic hormone (ACTH).

Results: The mean age of hypertensive children was 6.74 ± 3.14 years, while normotensive children were 7.22 ± 4.63 years. Good compliance to treatment was slightly higher in the hypertensive group (75% ± 42.01%) compared to the normotensive group (71.23% ± 44.96%). Hypertensive children had higher mean Weight SD (0.214 ± 1.020) and BMI Z scores (0.954 ± 0.805) scores than normotensive children (WtSD: -0.019 ± 1.482; BMI SD: 0.821 ± 1.286). Bone age advancement was more pronounced in hypertensives (Bone Age SD: 0.8 ± 2.127) versus normotensives (Bone Age SD: -0.167 ± 1.906). The mean hydrocortisone dose was similar between groups, but hypertensive children had higher levels of last measured 17OHP (23.94 ± 49.89) and lower levels of ACTH (76.36 ± 121.94) compared to their normotensive counterparts (17OHP: 19.65 ± 40.58; ACTH: 112.62 ± 183.94).

Conclusion: Children with CAH who develop hypertension exhibit distinct clinical and laboratory profiles, including higher Wt SD and BMI Z scores, advanced bone age, and different hormone levels compared to normotensive children. These findings suggest that hypertensive CAH patients have a unique phenotype that may require adjusted management strategies. Further research is warranted to explore the underlying mechanisms and the potential impact of early identification and treatment modifications on long-term outcomes.