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Left ventricular dysfunction and subclinical atherosclerosis in children with classic congenital adrenal hyperplasia: a single-center study from upper Egypt

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Abstract

Few studies assessed carotid artery intima-media thickness (CA-IMT) and left ventricular (LV) function in children with congenital adrenal hyperplasia (CAH) as compared to adults. This study aimed to assess carotid artery structural changes and myocardial function with CAH. The study included 32 children with classic CAH and 32 healthy children matched for age, gender, pubertal status, and socioeconomic status. Blood levels of high-sensitivity C-reactive protein (hs-CRP) and circulating endothelial cells (CECs) were measured. LV mass (LVM) and function were assessed using conventional echocardiography. Duplex ultrasonography was used to measure CA-IMT. Compared to controls, patients had higher hs-CRP and CEC concentrations (p < 0.001) and increased CA-IMT (p < 0.001), indicating vascular endothelial injury and subclinical atherosclerosis; higher LVM index (LVMI) (p < 0.001), indicating LV hypertrophy; and lower ratio of E/A wave and prolonged mitral deceleration time (DcT) and isovolumic relaxation times (IVRTs) (p < 0.001), indicating LV dysfunction. Abnormalities were marked in uncontrolled children on medical treatment. Testosterone levels were positively correlated with CA-IMT, LVMI, and DcT values.

Conclusion: This study indicates that children with CAH and enhanced androgen levels are at increased risk of vascular endothelial injury, subclinical atherosclerosis, and LV dysfunction. These findings highlight early monitoring of children with CAH for cardiovascular abnormalities.

What is known:

• There is an increased risk for cardio-metabolic abnormalities in patients with congenital adrenal hyperplasia (CAH).

• Limited studies assessed carotid artery wall thickness and left ventricular function in children with CAH as compared to adults.

What is new:

• Atherosclerotic changes, vascular endothelial injury, and left ventricular dysfunction may begin early in children with CAH.

• Children with CAH should be monitored for myocardial and vascular endothelial functions.

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Abbreviations

CAH:

Congenital adrenal hyperplasia

17-OHP:

17-Hydroxyprogesterone

hs-CRP:

High-sensitivity C-reactive protein

CECs:

Circulating endothelial cells

LVMI:

Left ventricular mass index

DcT:

Deceleration time

CA-IMT:

Carotid artery intima-media thickness

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Conflict of interest

All the authors declare no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding source

No funding was secured for this study.

Financial disclosure

The authors have no financial relationships relevant to this article to disclose.

Acknowledgments

KA participated in the design of the protocol of the study, coordination of the research, performance of the clinical part, analyses of the data, and writing the draft of the paper. HS participated in the design of the protocol of the study, performed the echocardiography, and participated in the analyses of the data and writing the draft of the paper. TS performed the laboratory investigation and participated in the analyses of the results. All the authors read and approved the manuscript. All the authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.

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Authors and Affiliations

  1. Department of Pediatrics, Faculty of Medicine, Assiut University, Assiut, Egypt

    Kotb Abbass Metwalley & Hekma Saad Farghaly

  2. Department of Clinical Pathology, Faculty of Medicine, Assiut University, Assiut, Egypt

    Tahra Sherief

  3. Pediatric Endocrinology Unit, Department of Pediatrics, Faculty of Medicine, Assiut University, B.O. 71111, Assiut, Egypt

    Kotb Abbass Metwalley

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  1. Kotb Abbass Metwalley
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  2. Hekma Saad Farghaly
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Correspondence to Kotb Abbass Metwalley.

Additional information

Communicated by Beat Steinmann

Revisions received: 19 August 2015/2 September 2015

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Metwalley, K.A., Farghaly, H.S. & Sherief, T. Left ventricular dysfunction and subclinical atherosclerosis in children with classic congenital adrenal hyperplasia: a single-center study from upper Egypt. Eur J Pediatr 175, 405–412 (2016). https://doi.org/10.1007/s00431-015-2634-1

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  • DOI: https://doi.org/10.1007/s00431-015-2634-1

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