Left ventricular dysfunction and subclinical atherosclerosis in children with classic congenital adrenal hyperplasia: a single-center study from upper Egypt
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.
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.
KeywordsCirculating endothelial cells Congenital adrenal hyperplasia intima thickness Left ventricular mass index
Congenital adrenal hyperplasia
High-sensitivity C-reactive protein
Circulating endothelial cells
Left ventricular mass index
Carotid artery intima-media thickness
- 1.Speiser PW, Azziz R, Baskin LS, Ghizzoni L, Hensle TW, Merke DP, Meyer-Bahlburg HF, Miller WL, Montori VM, Oberfield SE, Ritzen M, White PC, Endocrine Society (2010) Congenital adrenal hyperplasia due to steroid 21-hydroxylase deficiency: an endocrine society clinical practice guideline. J Clin Endocrinol Metab 95(9):4133–4160PubMedCentralCrossRefPubMedGoogle Scholar
- 6.Charmandari E, Weise M, Bornstein SR, Eisenhofer G, Keil MF, Chrousos GP, Merke DP (2002) Children with classic congenital adrenal hyperplasia have elevated serum leptin concentrations and insulin resistance: potential clinical implications. J Clin Endocrinol Metab 87(5):2114–2120CrossRefPubMedGoogle Scholar
- 9.Ubertini G, Bizzarri C, Grossi A, Gimigliano F, Ravà L, Fintini D, Cappa M (2009) Blood pressure and left ventricular characteristics in young patients with classical congenital adrenal hyperplasia due to 21-hydroxylase deficiency. Int J Pediatr Endocrinol 2009(2009):383610PubMedCentralCrossRefPubMedGoogle Scholar
- 17.Blumenthal S, Epps RP, Heavenrich R, Lauer RM, Lieberman E, Mirkin B, Mitchell SC, Boyar Naito V, O’Hare D, McFate Smith W, Tarazi RC, Upson D (1977) Report of the task force on blood pressure control in children. Pediatrics 59(5 2 suppl):797–820, I-II Google Scholar
- 18.Diabetes Endocrine Metabolism Pediatric Unit, Cairo University Children’s Hospital (2002). Egyptian growth curves. Available from: http://dempuegypt.blogspot.com. Accessed 13 Aug 2014
- 20.Greulich GWW, Pyle SI (1959) Radiographic atlas of skeletal development of the hand and wrist, 2nd edn. Stanford University Press, StanfordGoogle Scholar
- 21.Park MK (2008) Pediatric cardiology for practitioners. Noninvasive techniques (Chap. 6), 5th edn., an imprint of Elsevier. Part 2: special tools in evaluation of cardiac patients. Elsevier, MosbyGoogle Scholar
- 22.Shan DJ, De Maria A, Kisslo J, Weyman A (1978) The committee on M-mode standardization of the American Society of Echocardiography. Recommendations regarding quantitation in M-mode echocardiography: result of a survey of echocardiographic measurements. Circulation 58(6):1072–1083CrossRefGoogle Scholar
- 26.Mooij CF, Kroese JM, Claahsen-van der Grinten HL, Tack CJ, Hermus AR (2010) Unfavorable trends in cardiovascular and metabolic risk in paediatric and adult patients with congenital adrenal hyperplasia? Clin Endocrinol (Oxf) 73(2):137–146Google Scholar
- 27.Wasniewska M, Balsamo A, Valenzise M, Manganaro A, Faggioli G, Bombaci S, Conti V, Ferri M, Aversa T, Cicognani A, De Luca F (2013) Increased large artery intima media thickness in adolescents with either classical or non-classical congenital adrenal hyperplasia. J Endocrinol Investig 36(1):12–15Google Scholar
- 30.Marra AM, Improda N, Capalbo D, Salzano A, Arcopinto M, De Paulis A, Alessio M, Lenzi A, Isidori AM, Cittadini A, Salerno M (2015) Cardiovascular abnormalities and impaired exercise performance in adolescents with congenital adrenal hyperplasia. J Clin Endocrinol Metab 100(2):644–652CrossRefPubMedGoogle Scholar