Long-term Low–dose Dexamethasone Treatment of Non-Classical Congenital Adrenal Hyperplasia Patients Improves Fertility Without Increasing Metabolic or Bone Abnormalities

Program: Abstracts - Orals, Featured Poster Presentations, and Posters
Session: SAT 532-553-Hyperandrogenic Disorders
Basic/Clinical
Saturday, June 15, 2013: 1:45 PM-3:45 PM
Expo Halls ABC (Moscone Center)

Poster Board SAT-553
Larissa Garcia Gomes*, Guiomar Madureira, Berenice Bilharinho Mendonca and Tania A Bachega
Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
Introductions: There are no randomized trials comparing different treatments for non-classical congenital adrenal hyperplasia (NCCAH). Recently, concerns have arisen about the risks associated with long-term dexamethasone use in CAH, such as metabolic diseases and osteoporosis. Objective: to evaluate whether dexamethasone treatment influences metabolic status, bone mass and/or fertility in NCCAH patients. Methods: 32 NCCAH adult women treated with dexamethasone for at least 2 years were selected. Dexamethasone doses were adjusted twice/yr to obtain normal androgen levels according to age/sex. Medical history including years on dexamethasone therapy and fertility rate were assessed. Physical and biochemical parameters including height, weight, waist circumference, blood pressure, glucose, insulin, cholesterol and triglycerides levels were measured. Bone mineral density was assessed by DXA in 21/32 patients. Results: NCCAH patients had a median age of 35yrs (range 19-66yrs), 6/32 patients were older than 50 yrs and postmenopausal. The median dexamethasone dose was 0.2mg (range 0.1-0.375mg), and the median time of dexamethasone use was 11.3yrs (2-24yrs). The prevalence of overweight and obesity were 28.1 and 25% respectively. Median waist circumference was 79.5cm (range 63-110). Hypertension was detected in 15.6% of patients. Diabetes and insulin resistance were found in 3% and 21.9%, respectively. Lipid profiles were normal, except in 3/32 patients with low HDL and 1/32 patient with high LDL. Frequencies of these co-morbidities were similar to our reference population. Median lumbar spine, total hip and femoral neck Z-scores were -0.1, 0.1, and -0.1, respectively. Z-scores lower than -1.0 but greater than -2.5 were seen at the lumbar spine and femoral neck in 3/21 and 3/21 patients, respectively. No patient had a Z-score lower than -2.5. Regarding fertility, 20/32 women wanted pregnancy, 31 pregnancies occurred: 22 live births (17 with dexamethasone and 5 without dexamethasone) and 9 miscarriages (8/9 without dexamethasone). Conclusions: The rate of miscarriage decreases with dexamethasone treatment. Long-term low-dose dexamethasone treatment did not increase metabolic and bone diseases in this small cohort.

Nothing to Disclose: LGG, GM, BBM, TAB

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

Sources of Research Support: FAPESP #2009/54238-2
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