European Journal of Pediatrics

, Volume 175, Issue 3, pp 405–412 | Cite as

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

  • Kotb Abbass Metwalley
  • Hekma Saad Farghaly
  • Tahra Sherief
Original Article


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.


Circulating 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


Deceleration time


Carotid artery intima-media thickness


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Copyright information

© Springer-Verlag Berlin Heidelberg 2015

Authors and Affiliations

  1. 1.Department of Pediatrics, Faculty of MedicineAssiut UniversityAssiutEgypt
  2. 2.Department of Clinical Pathology, Faculty of MedicineAssiut UniversityAssiutEgypt
  3. 3.Pediatric Endocrinology Unit, Department of Pediatrics, Faculty of MedicineAssiut UniversityAssiutEgypt

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