Cardiovascular risk factors in children and adolescents with congenital adrenal hyperplasia due to 21-hydroxylase deficiency

Authors

  • Anbezhil Subbarayan,

    1. Department of Endocrinology, Great Ormond Street Hospital for Children, London, UK
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  • Mehul T. Dattani,

    1. Department of Endocrinology, Great Ormond Street Hospital for Children, London, UK
    2. Developmental Endocrinology Research Group, UCL Institute of Child Health, London, UK
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  • Catherine J. Peters,

    1. Department of Endocrinology, Great Ormond Street Hospital for Children, London, UK
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  • Peter C. Hindmarsh

    Corresponding author
    1. Department of Endocrinology, Great Ormond Street Hospital for Children, London, UK
    2. Developmental Endocrinology Research Group, UCL Institute of Child Health, London, UK
    • Correspondence: Peter Hindmarsh, Developmental Endocrinology Research Group, UCL Institute of Child Health, 30 Guilford Street, London WC1N 1EH, UK. Tel.: +44 207 405 9200 ext 5813; E-mail: p.hindmarsh@ucl.ac.uk

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Summary

Objective

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.

Methods

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.

Results

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.

Conclusion

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.

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