Session: FP03-Glucocorticoids & Glucocorticoid Actions
Room 130 (Moscone Center)
Poster Board SAT-1
Methods: Cross-sectional analysis of 151 adults with 21-hydroxylase deficiency (50M: 47 with classic and 3 with non-classic CAH; 101F: 75 with classic and 26 with non-classic CAH) aged 18-69 years in whom QoL (SF-36), glucocorticoid regimen, anthropometric and metabolic measures were recorded. Relationships were examined between QoL, type of glucocorticoid (hydrocortisone, prednisolone and dexamethasone), and dose of glucocorticoid expressed as prednisolone dose equivalent (PreDEq). QoL was expressed as z-scores calculated from matched controls (14,430 subjects from UK population). Principal components analysis (PCA) was undertaken to identify clusters of associated clinical and biochemical features and the principal component (PC) scores used in regression analysis as predictor of QoL.
Results: QoL scores were associated with type of glucocorticoid treatment for vitality (P=0.002) and mental health (P=0.011), with higher z-scores indicating better QoL in patients on hydrocortisone than in patients receiving prednisolone or dexamethasone (P<0.05). QoL did not relate to PreDEq or mutation severity. PCA identified three PCs (PC1, disease control; PC2, adiposity and insulin resistance; PC3, blood pressure and mutations) that explained 61% of the variance in observed variables. Stepwise multiple regression analysis demonstrated that PC2 (comprising waist circumference, serum triglycerides, HOMA-IR and HDL-cholesterol) was associated with QoL scores, specifically impaired physical functioning, bodily pain, general health, Physical Component Summary Score (P<0.001) and vitality (P=0.002).
Conclusions: Increased adiposity, insulin resistance and use of prednisolone or dexamethasone are associated with impaired QoL in adults with CAH independently of mutation severity. Intervention trials are required to establish whether choice of glucocorticoid treatment and/or weight loss can improve QoL in CAH adults.
Disclosure: SH: Advisory Group Member, Viropharma. RJR: Founder, Diurnal. Nothing to Disclose: TSH, NK, DSW, GSC, AR, RHS, BRW, WA
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