FP37-6 Hypertension and Obesity in Children and Adolescents with Congenital Adrenal Hyperplasia due to 21-hydroxylase Deficiency

Program: Abstracts - Orals, Featured Poster Presentations, and Posters
Session: FP37-Clinical Pediatric Endocrinology
Clinical
Monday, June 17, 2013: 10:45 AM-11:15 AM
Presentation Start Time: 11:10 AM
Room 102 (Moscone Center)

Poster Board MON-597
Anbezhil Subbarayan*1, Mehul Tulsidas Dattani2, Catherine J Peters1 and Peter C Hindmarsh1
1Great Ormond Street Hospital, London, United Kingdom, 2UCL Institute of Child Health, London, United Kingdom
Background

Congenital adrenal hyperplasia (CAH) is the commonest inherited disorder of adrenal steroid biosynthesis. Several reports have suggested an increased prevalence of cardiovascular risk factors. Whether this relates to the condition or treatment modalities is unclear. In the light of changes to treatment regimens, we have reassessed the prevalence of obesity and hypertension in our current cohort of patients with CAH due to 21-hydroxylase deficiency.

Methods

A retrospective cross sectional study of 107 children (39 M) [median age 9.2 yrs (range 0.4-20.5 yrs)] diagnosed with CAH due to 21-hydroxylase deficiency and treated with hydrocortisone and 9 alpha-fludrocortisone. Height and weight were measured and body mass index (BMI) derived and all data were expressed as standard deviation scores (SDS) using UK Growth reference data. Blood pressure (BP) was measured six hourly for 24 hours and average systolic (SBP) and diastolic (DBP) blood pressure calculated and expressed as SDS using the Fourth Taskforce data set.

Results

23.6% (33% males; 18% females) of the cohort were obese (BMI >2SDS). Height SDS was similar but overall weight SDS and BMI SDS was significantly higher (P<0.001) when compared to the UK population mean. 19 (20.9%) out of 91 patients (20% males; 21% females) had systolic hypertension and 8 (8.8%) patients (8.6% males; 8.9% females) had diastolic hypertension. Mean SBP [108(SD 13.5) mm Hg] was significantly higher than the reference population (P=0.000) but no significant difference was seen with mean DBP [59(SD 10.8) mm Hg (P=0.07)]. Both SBP SDS and DBP SDS were negatively correlated with age (r=-0.21, P=0.02;    r=-0.27, P=0.012 respectively) but were not related to BMI SDS (r=0.11, P=0.28; r=0.1, P=0.36 respectively). In stepwise multiple linear regression analysis, DBP SDS was predicted by mean serum cortisol and 9 alpha-fludrocortisone dose (Adjusted R Square=0.22).

Conclusion

Despite a reduction in hydrocortisone dosing over the last decade our children with CAH are still obese and have significantly higher SBP. Higher SBP was not related to higher BMI suggesting that treatment remains a factor in generating higher BP. The data suggest that further titration of steroid doses could reduce long-term comorbidities in these children.

Nothing to Disclose: AS, MTD, CJP, PCH

*Please take note of The Endocrine Society's News Embargo Policy at http://www.endo-society.org/endo2013/media.cfm

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