Growth and Metabolic Syndrome (MetS) criteria in young children with classic Congenital Adrenal Hyperplasia (CAH) treated with corticosteroids (CS)
Metabolic Syndrome in CAH
Keywords:
Congenital adrenal hyperplasia (CAH), children, cardiometabolic risk factors, blood pressure, metabolic syndrome.Abstract
Background: Treatment of children with congenital adrenal hyperplasia (CAH) with corticosteroids (CS) may increase the risk for developing different components of metabolic syndrome (MetS). Aim: We assessed the occurrence of cardiometabolic risk factors in children with CAH on treatment with CS since early infancy. Methods: Data of 30 children with CAH were analyzed retrospectively. They have received hydrocortisone (HC; n = 11) or prednisolone (P; n= 19) and fludrocortisone (0.1- 0.15 mg once daily) since early infancy. The different cardiometabolic criteria including blood pressure (BP), fasting glucose, low-density lipoprotein (LDL), and serum cholesterol concentrations were studied and compared with the data for 66 age-matched obese children. Results: Children with CAH on treatment for > 5 years had a high rate of obesity and overweight (60%) and short stature (23.3%), respectively. They had higher occurrences of abnormal cardio-metabolic components including high LDL and triglyceride and BP as well as increased carotid intima-media thickness (CIMT). Females had higher body mass index (BMI) and BP compared to males. The less controlled group was older and had faster linear growth compared to the controls. In the CAH group, BP and CIMT were correlated significantly with BMI-SDS and weight-standard deviation score (Wt-SDS). Neither the level of 17-hydroxy-Progesterone (17-OHP), nor the HC dose was correlated with BP, CIMT or BMI. Conclusion: These findings suggest the role played by excessive weight gain on the increased cardiometabolic risk factors in children with CAH on treatment with CS.
References
Trapp CM, Speiser PW, Oberfield SE. Congenital adrenal hyperplasia: an update in children. Curr Opin Endocrinol Diabetes Obes. 2011;18:166-70.
Alberti KGM, Zimmet P, Shaw J. The metabolic syndrome—a new worldwide definition. Lancet 2005;366:1059–62.
Organization WH: Definition, diagnosis, and classification of diabetes mellitus and its complications: report of a WHO consultation. Part 1, Diagnosis and classification of diabetes mellitus. World Health Organization; 1999
Torky A, Sinaii N, Jha S, Desai J, El-Maouche D, Mallappa A, Merke DP. Cardiovascular Disease Risk Factors and Metabolic Morbidity in a Longitudinal Study of Congenital Adrenal Hyperplasia. J Clin Endocrinol Metab 2021;106:e5247-e57.
Subbarayan A, Dattani MT, Peters CJ, Hindmarsh PC. Cardiovascular Risk Factors in Children and Adolescents with Congenital Adrenal Hyperplasia Due to 21-Hydroxylase Deficiency. Clin Endocrinol 2014; 80:471–7.
Bonfig W, Roehl FW, Riedl S, et al.. Blood Pressure in a Large Cohort of Children and Adolescents With Classic Adrenal Hyperplasia (CAH) Due to 21-Hydroxylase Deficiency. Am J Hypertens 2016; 29:266–72.
Marra AM, Improda N, Capalbo D, et al. Cardiovascular Abnormalities and Impaired Exercise Performance in Adolescents With Congenital Adrenal Hyperplasia. J Clin Endocrinol Metab 2015; 100:644–52.
Akyürek N, Atabek ME, Eklioğlu BS, Alp H. Ambulatory Blood Pressure and Subclinical Cardiovascular Disease in Patients With Congenital Adrenal Hyperplasia: A Preliminary Report. J Clin Res Pediatr Endocrinol 2015;7:13–8.
Improda N, Barbieri F, Ciccarelli GP, Capalbo D, Salerno M. Cardiovascular Health in Children and Adolescents With Congenital Adrenal Hyperplasia Due to 21-Hydroxilase Deficiency. Front Endocrinol 2019; 10:212.
Falhammar H, Frisen L, Hirschberg AL, et al.. Increased Cardiovascular and Metabolic Morbidity in Patients With 21-Hydroxylase Deficiency: A Swedish Population-Based National Cohort Study. J Clin Endocrinol Metab 2015; 100:3520–8.
Kim MS, Fraga NR, Minaeian N, Geffner ME. Components of Metabolic Syndrome in Youth With Classical Congenital Adrenal Hyperplasia. Front Endocrinol (Lausanne) 2022;13:848274
Weiss R, Dziura J, Burgert TS, et al. Obesity and the metabolic syndrome in children and adolescents. N Engl J Med 2004;350:2362-74.
Hickman TB, Briefel RR, Carroll MD, et al. Distributions, and trends of serum lipid levels among United States children and adolescents ages 4-19 years: data from the Third National Health and Nutrition Examination Survey. Prev Med 1998;27:879-90
Stein JH, Korcarz CE, Hurst RT, et al. Use of carotid ultrasound to identify subclinical vascular disease and evaluate cardiovascular disease risk: a consensus statement from the American Society of Echocardiography Carotid Intima-Media Thickness Task Force. Endorsed by the Society for Vascular Medicine. J Am Soc Echocardiogr 2008; 21:93-111-
Sarafoglou K, Forlenza GP, Yaw Addo O, et al. Obesity in Children With Congenital Adrenal Hyperplasia in the Minnesota Cohort: Importance of Adjusting Body Mass Index for Height- Age. Clin Endocrinol 2017; 86:708–16.
Takishima S, Nakajima K, Nomura R, et al. Lower Body Weight and BMI at Birth Were Associated With Early Adiposity Rebound in 21-Hydroxylase Deficiency Patients. Endocr J 2016; 63:983–90
Bhullar G, Tanawattanacharoen VK, Yeh MY, et al. Early Adiposity Rebound Predicts Obesity and Adiposity in Youth With Congenital Adrenal Hyperplasia. Horm Res Paediatr 2020; 93:609–15.
Akyürek N, Atabek ME, Eklioğlu BS, Alp H. Ambulatory Blood Pressure and Subclinical Cardiovascular Disease in Patients With Congenital Adrenal Hyperplasia: A Preliminary Report. J Clin Res Pediatr Endocrinol 2015;7:13–8.
Kim MS, Ryabets-Lienhard A, Dao-Tran A, et al. Increased Abdominal Adiposity in Adolescents and Young Adults With Classical Congenital Adrenal Hyperplasia Due to 21-Hydroxylase Deficiency. J Clin Endocrinol Metab 2015;100:E1153–59.
Vijayan R, Bhavani N, Pavithran PV, et al. Metabolic Profile, Cardiovascular Risk Factors and Health-Related Quality of Life in Children, Adolescents and Young Adults With Congenital Adrenal Hyperplasia. J Pediatr Endocrinol Metab 2019; 32:871–7.
Fardet L, Feve B. Systemic glucocorticoid therapy: a review of its metabolic and cardiovascular adverse events. Drugs 2014;74:1731–45.
Peckett AJ, Wright DC, Riddell MC. The effects of glucocorticoids on adipose tissue lipid metabolism. Metabolism 2011;60:1500–10.
Gomes LG, Mendonca BB, Bachega TASS. Long-Term Cardio-Metabolic Outcomes in Patients With Classical Congenital Adrenal Hyperplasia: Is the Risk Real? Curr Opin Endocrinol Diabetes Obes 2020;27:155–61.
Mooij CF, van Herwaarden AE, Sweep FCGJ, et al. Cardiovascular and Metabolic Risk in Pediatric Patients with Congenital Adrenal Hyperplasia Due to 21 Hydroxylase Deficiency. J Pediatr Endocrinol Metab 2017; 30: 957–66.
Hashemi Dehkordi E, Khaheshi S, Mostofizadeh N, Hashemipour M. Cardiovascular Risk Factors in Children and Adolescents With Congenital Adrenal Hyperplasia. Adv Biomed Res 2021; 10:19.
Quinkler M, Ekman B, Marelli C, Uddin S, Zelissen P, Murray RD; EU-AIR Investigators. Prednisolone is associated with a worse lipid profile than hydrocortisone in patients with adrenal insufficiency. Endocr Connect 2017;6:1-8.
Ross IL, Marais AD. The influence of glucocorticoids on lipid and lipoprotein metabolism and atherosclerosis. S Afr Med J 2014;104:671-4.
Bonfig W, Roehl FW, Riedl S, et al. Blood Pressure in a Large Cohort of Children and Adolescents with Classic Adrenal Hyperplasia (CAH) Due to 21-Hydroxylase Deficiency. Am J Hypertens 2016; 29:266–72
Pasquali R, Oriolo C. Obesity and Androgens in Women. Front Horm Res 2019;53:120-34.
Merke DP, Poppas DP. Management of adolescents with congenital adrenal hyperplasia. Lancet Diabetes Endocrinol 2013;1:341-52.
Downloads
Published
Issue
Section
License
Copyright (c) 2022 Shaymaa Elsayed Abdel Meguid , Ashraf T Soliman, Vincenzo De Sanctis , Ahmed Mohamed Said Abougabal , Magdy Abd El Fattah Ramadan, Mohamed Hassan, Noor Hamed , Shayma Ahmed
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Transfer of Copyright and Permission to Reproduce Parts of Published Papers.
Authors retain the copyright for their published work. No formal permission will be required to reproduce parts (tables or illustrations) of published papers, provided the source is quoted appropriately and reproduction has no commercial intent. Reproductions with commercial intent will require written permission and payment of royalties.
How to Cite
