Cardiovascular risk factors in children and adolescents with congenital adrenal hyperplasia due to 21-hydroxylase deficiency
Article first published online: 8 JUL 2013
© 2013 The Authors. Clinical Endocrinology published by John Wiley & Sons Ltd.
This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.
Volume 80, Issue 4, pages 471–477, April 2014
How to Cite
Subbarayan, A., Dattani, M. T., Peters, C. J. and Hindmarsh, P. C. (2014), Cardiovascular risk factors in children and adolescents with congenital adrenal hyperplasia due to 21-hydroxylase deficiency. Clinical Endocrinology, 80: 471–477. doi: 10.1111/cen.12265
- Issue published online: 10 MAR 2014
- Article first published online: 8 JUL 2013
- Accepted manuscript online: 10 JUN 2013 01:46AM EST
- Manuscript Accepted: 4 JUN 2013
- Manuscript Revised: 10 MAY 2013
- Manuscript Revised: 26 MAR 2013
- Manuscript Received: 26 FEB 2013
The prevalence of cardiovascular risk factors in congenital adrenal hyperplasia (CAH) varies widely. In the light of recent changes in treatment regimens, we have reassessed the prevalence of these risk factors in our current cohort of patients with CAH due to P450c21 deficiency.
A retrospective cross-sectional study of 107 children (39 m) with CAH aged 9·2 years (range 0·4–20·5 years). Anthropometric, systolic (SBP) and diastolic (DBP) blood pressure data were collected and expressed as standard deviation scores (SDS) using UK growth reference data and the Fourth Task Force data set, respectively. Fasting blood glucose with plasma insulin and lipids was measured, and insulin resistance (HOMA IR) calculated using the homoeostasis assessment model.
23·6% (33% men; 18% women) of the cohort were obese (BMI SDS>2). BMI SDS was significantly higher (P < 0·001) when compared with the UK population. Nineteen (20·9%) of 91 patients (20% men; 21% women) had systolic hypertension and 8 [8·8% (8·6% men; 8·9% women)] had diastolic hypertension. Mean SBP [108 (SD 13·5)] mm Hg was significantly higher than the normal population (P < 0·001), but mean DBP was not (P = 0·07). Both SBP SDS and DBP SDS were not related to BMI SDS. 9·5% of the subjects had hyperlipidaemia, but HOMA IR was more favourable compared with the normal population.
Despite a reduction in steroid doses over the last decade, a number of children with CAH are still obese and hypertensive. Whether this reflects general population trends or indicates a need to further optimize treatment regimens remains to be determined.