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Carotid intima media thickness and other cardiovascular risk factors in children with congenital adrenal hyperplasia

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Abstract

Purpose

Patients with congenital adrenal hyperplasia (CAH) are at increased risk for cardiovascular disease due to many factors. The aim of this study is to investigate the presence of dyslipidemia, insulin resistance, and subclinical atherosclerosis as indicated by carotid intima media thickness in children with congenital adrenal hyperplasia.

Methods

Thirty-two children with congenital adrenal hyperplasia (3–17 years) were compared with 32 healthy controls. All underwent anthropometric evaluation, measurement of fasting lipids, glucose, insulin, oral glucose tolerance test (OGTT), homeostasis model assessment for insulin resistance (HOMA-IR), and carotid intima media thickness (CIMT).

Results

Fasting glucose, glucose at 30, 60, 90, and 120 min during OGTT were significantly higher in patients. HOMA-IR was also significantly higher in patients (p = 0.036). Patients had significantly higher CIMT (p = 0.003), and higher systolic blood pressure. (p = 0.04). No significant difference existed in lipid profile. Both systolic and diastolic blood pressures correlated with treatment duration (p = 0.002, p = 0.043, respectively).

Conclusion

Children with CAH are at increased risk of insulin resistance, glucose intolerance, early atherosclerosis, and cardiovascular disease. Screening of these patients at an early age is recommended.

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References

  1. Charmandari E, Chrousos GP (2006) Metabolic syndrome manifestations in classic congenital adrenal hyperplasia. Do they predispose to atherosclerotic cardiovascular disease and secondary polycystic ovary syndrome? Ann NY Acad Sci 1083:37–53

    Article  PubMed  CAS  Google Scholar 

  2. Zimmermann A, Grigorescu-Sido P, AlKhzouz C, Patberg K, Bucerzan S, Schulze E, Zimmermann T, Rossmann H, Geis HC, Lackner KJ, Weber MM (2010) Alterations in lipid and carbohydrate metabolism in patients with classic congenital adrenal hyperplasia due to 21-hydroxylase deficiency. Horm Res Paediatr 74:41–49

    Article  PubMed  CAS  Google Scholar 

  3. Speiser PW, White PC (2003) Congenital adrenal hyperplasia. N Engl J Med 349:776–788

    Article  PubMed  CAS  Google Scholar 

  4. White PC, Speiser PW (2000) Congenital adrenal hyperplasia due to 21-hydroxylase deficiency. Endocr Rev 21:245–291

    PubMed  CAS  Google Scholar 

  5. Charmandari E, Hindmarsh PC, Johnston A, Brook CG (2001) Congenital adrenal hyperplasia due to 21-hydroxylase deficiency: alterations in cortisol pharmacokinetics at puberty. J Clin Endocrinol Metab 86:2701–2708

    Article  PubMed  CAS  Google Scholar 

  6. Van Wyk JJ, Gunther DF, Ritzen EM, Wedell A, Cutler GB Jr, Migeon CJ, New MI (1996) The use of adrenalectomy as a treatment for congenital adrenal hyperplasia. J Clin Endocrinol Metab 81:3180–3190

    PubMed  Google Scholar 

  7. Völkl TM, Simm S, Beier C, Dorr HG (2006) Obesity among children and adolescents with classic congenital adrenal hyperplasia due to 21-hydroxylase deficiency. Pediatrics 117:e98–e105

    Article  PubMed  Google Scholar 

  8. Charmandari E, Weise M, Bornstein S, Eisenhofer G, Keil MF, Chrousis GP, Merke DP (2002) Children with classic congenital hyperplasia have elevated serum leptin concentrations and insulin resistance: potential clinical implications. J Clin Endocrinol Metab 87:2114–2120

    Article  PubMed  CAS  Google Scholar 

  9. Yazıcı D, Yavuz D, Öğünç AV, Sirikçi Ö, Toprak A, Deyneli O, Akalın S (2012) Serum adipokine levels in type 1 diabetic patients: association with carotid intima media thickness. Metab Syndr Relat Disord 10(1):26–31

    Article  PubMed  Google Scholar 

  10. Cheng KS, Mikhaulidis DP, Hamilton G, Seifalian AM (2002) A review of the carotid and femoral intima-media thickness as an indicator of the presence of peripheral vascular disease and cardiovascular risk factors. Cardiovasc Res 54:528–538

    Article  PubMed  CAS  Google Scholar 

  11. Sempe M, Pedrong G, Roy-Ternot NP (1979) Auxologie le methods et sequences. Theraplix, Paris

    Google Scholar 

  12. Cole TJ, Freeman JV, Preece MA (1995) Body mass index reference curves for the UK 1990. Arch Dis Child 73(1):25–29

    Article  PubMed  CAS  PubMed Central  Google Scholar 

  13. Tanner JM (1962) Growth at adolescence. Blackwell Scientific Publications, Oxford. http://www.epi.umn.edu/let/pubs/img/adol_ch1.pdf. Accessed 10 Apr 2013

  14. National High Blood Pressure Education Program Working Group on High Blood Pressure in Children and Adolescents (2004) The fourth report on the diagnosis, evaluation, and treatment of high blood pressure in children and adolescents. Pediatrics 114(2 Suppl 4th report):555–576

  15. 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(2 Suppl):I–II, 797–820

  16. Friedewald WT, Levy RI, Fredrickson DS (1972) Estimation of the concentration of low-density lipoprotein cholesterol in plasma without use of the preparative ultracentrifuge. Clin Chem 18(6):499–502

    PubMed  CAS  Google Scholar 

  17. Zimmet P, Alberti K, George MM, Tajima M, Silink M, Arslanian S, Wong G, Bennett P, Shaw J, Caprio S, IDF Consensus Group (2007) The metabolic syndrome in children and adolescents: an IDF consensus report. Pediatr Diabetes 8:299–306

    Article  PubMed  Google Scholar 

  18. World Health Organization (1999) Definition, diagnosis and classification of diabetes mellitus and its complications. Genebra: report of WHO a consultation. Part 1: diagnosis and classification of diabetes mellitus

  19. Mattews DR, Hosker JP, Rudenski AS, Naylor BA, Treacher DF, Turner RC (1985) Homeostasis model assessment: insulin resistance and beta-cell function from fasting plasma glucose and insulin concentrations in man. Diabetologia 28:412–419

    Article  Google Scholar 

  20. Atabek ME, Pirgon O (2007) Assessment of insulin sensitivity from measurements in fasting state and during an oral glucose tolerance test in obese children. J Pediatr Endocrinol Metab 20(2):187–195

  21. Greulich GWW, Pyle SI (1959) Radiographic atlas of skeletal development of the hand and wrist, 2 edn. Stanford University Press, Stanford

  22. Subbarayan A, Dattani MT, Peters CJ, Hindmarsh PC (2014) Cardiovascular risk factors in children and adolescents with congenital adrenal hyperplasia due to 21-hydroxylase deficiency. Clin Endocrinol (Oxf) 80:471–477

    Article  CAS  Google Scholar 

  23. Lorenz MW, Markus HS, Bots ML, Rosvall M, Sitzer M (2007) Prediction of clinical cardiovascular events with carotid intima-media thickness: a systematic review and meta-analysis. Circulation 115:459–467

    Article  PubMed  Google Scholar 

  24. Mooij CF, Kroese JM, Claahsen-van der Grinten HL, Tack CJ, Hermus Ad RMM (2010) Unfavourable trends in cardiovascular and metabolic risk in paediatric and adult patients with congenital adrenal hyperplasia? Clin Endocrinol 73:137–146

    CAS  Google Scholar 

  25. Harrington J, Peña AS, Gent R, Hirte C, Couper J (2012) Adolescents with congenital adrenal hyperplasia because of 21-hydroxylase deficiency have vascular dysfunction. Clin Endocrinol (Oxf) 76(6):837–842

    Article  CAS  Google Scholar 

  26. Falhammar H, Filipsson H, Holmdahl G, Janson PO, Nordenskjold A, Hagenfeldt K, Thoren M (2007) Metabolic profile and body composition in adult women with congenital adrenal hyperplasia due to 21-hydroxylase deficiency. J Clin Endocrinol Metab 92:110–116

    Article  PubMed  CAS  Google Scholar 

  27. Arlt W, Willis DS, Wild SH, Krone N, Doherty EJ, Hahner S, Han TS, Carroll PV, Conway GS, Rees DA, Stimson RH, Walker BR, Connell JM, Ross RJ (2010) Health status of adults with congenital adrenal hyperplasia: a cohort study of 203 patients. J Clin Endocrinol Metab 95:5110–5121

    Article  PubMed  CAS  PubMed Central  Google Scholar 

  28. Finkielstain GP, Kim MS, Sinaii N, Nishitani M, Van Ryzin C, Hill SC, Reynolds JC, Hanna RM, Merke DP (2012) Clinical characteristics of a cohort of 244 patients with congenital adrenal hyperplasia. J Clin Endocrinol Metab 97:4429–4438

    Article  PubMed  CAS  PubMed Central  Google Scholar 

  29. Craig R, Mindell J (eds) (2011) Health survey for England 2010. NHS Information Centre, London

    Google Scholar 

  30. Stikkelbroeck NM, Oyen WJ, van der Wilt GJ, Hermus Ad RMM, Otten BJ (2003) Normal bone mineral density and lean body mass, but increased fat mass, in young adult patients with congenital adrenal hyperplasia. J Clin Endocrinol Metab 88:1036–1042

    Article  PubMed  CAS  Google Scholar 

  31. Völkl TMK, Simm D, Dotsch J, Rascher W, Dorr HG (2006) Altered 24-hour blood pressure profiles in children and adolescents with classical congenital adrenal hyperplasia due to 21-hydroxylase deficiency. J Clin Endocrinol Metab 91:4888–4895

    Article  PubMed  Google Scholar 

  32. Reisch N, Arlt W, Krone N (2011) Health problems in congenital adrenal hyperplasia due to 21-hydroxylase deficiency. Horm Res Paediatr 76:73–85

    Article  PubMed  CAS  Google Scholar 

  33. Roche EF, Charmandari E, Dattani MT, Hindmarsh PC (2003) Blood pressure in children and adolescents with congenital adrenal hyperplasia (21-hydroxylase deficiency): a preliminary report. Clin Endocrinol 58:589–596

    Article  Google Scholar 

  34. de Silva KS, Kanumakala S, Brown JJ, Jones CL, Warne GL (2004) 24-hour ambulatory blood pressure profile in patients with congenital adrenal hyperplasia––a preliminary report. J Pediatr Endocrinol Metab 17:1089–1095

    PubMed  Google Scholar 

  35. Nebesio TD, Eugster EA (2006) Observation of hypertension in children with 21-hydroxylase deficiency: a preliminary report. Endocrine 30:279–282

    Article  PubMed  CAS  Google Scholar 

  36. Williams RM, Deeb A, Ong KK, Bich W, Murgatroyd PR, Hughes IA, Acerini CL (2010) Insulin sensitivity and body composition in children with classical and nonclassical congenital adrenal hyperplasia. Clin Endocrinol (Oxf) 72:155–160

    Article  CAS  Google Scholar 

  37. Paula FJ, Gouveia GM, Piccinato CE, Moreira AC, Foss MC (1994) Androgen-related effects on peripheral glucose metabolism in women with congenital adrenal hyperplasia. Horm Metab Res 26:552–556

    Article  PubMed  CAS  Google Scholar 

  38. Mnif MF, Kamoun M, Mnif F, Charfi N, Ben Naceur B, Kallel N, Rekik N, Mnif Z, Sfar MH, Sfar MT, Hachicha M, Abid M (2012) Metabolic profile and cardiovascular risk factors in adult patients with congenital adrenal hyperplasia due to 21-hydroxylase deficiency. Indian J Endocrinol Metab 16(6):939–946

    Article  PubMed  CAS  PubMed Central  Google Scholar 

  39. Vo¨lkl TMK, Simm D, Ko¨rner A, Rascher W, Kiess W, Kratzsch J, Dorr HJ (2009) Does an altered leptin axis play a role in obesity among children and adolescents with classical congenital adrenal hyperplasia due to 21-hydroxylase deficiency? Eur J Endocrinol 160:239–247

    Article  Google Scholar 

  40. Bo¨ttner A, Kratzsch J, Muller G, Kapellen TM, Bluher S, Keller E, Bluher M, Kiess W (2004) Gender differences of adiponectin levels develop during the progression of puberty and are related to serum androgen levels. J Clin Endocrinol Metab 89:4053–4061

    Article  Google Scholar 

  41. Fallo F, Scarda A, Sonino N, Paoletta A, Boscaro M, Pagano C, Federspil G, Vettor R (2004) Effect of glucocorticoids on adiponectin: a study in healthy subjects and in Cushing’s syndrome. Eur J Endocrinol 150:339–344

    Article  PubMed  CAS  Google Scholar 

  42. Degawa-Yamauchi M, Moss KA, Bovenkerk JE, Shankar SS, Morrison CL, Lelliott CJ, Vidal-Puig A, Jones R, Considine RV (2005) Regulation of adiponectin expression in human adipocytes: effects of adiposity, glucocorticoids, and tumor necrosis factor alpha. Obes Res 13:662–669

    Article  PubMed  CAS  Google Scholar 

  43. Vo¨lkl TMK, Simm D, Ko¨rner A, Kiess W, Kratzsch J, Dorr HG (2009) Adiponectin levels are high in children with classic congenital adrenal hyperplasia (CAH) due to 21-hydroxylase deficiency. Acta Paediatr 98:885–891

    Article  Google Scholar 

  44. Sartorato P, Zulian E, Benedini S, Mariniello B, Schiavi F, Bilora F, Pozzan G, Greggio N, Pagnan A, Mantero F, Scaroni C (2007) Cardiovascular risk factors and ultrasound evaluation of intima-media thickness at common carotids, carotid bulbs, and femoral and abdominal aorta arteries in patients with classic congenital adrenal hyperplasia due to 21-hydroxylase deficiency. J Clin Endocrinol Metab 92:1015–1018

    Article  PubMed  CAS  Google Scholar 

  45. Bachelot A, Plu-Bureau G, Thibaud E, Laborde K, Pinto G, Samara D, Nihoul-Fekete C, Kuttenn F, Polak M, Touraine P (2007) Long-term outcome of patients with congenital adrenal hyperplasia due to 21-hydroxylase deficiency. Horm Res 67:268–276

    Article  PubMed  CAS  Google Scholar 

  46. Falhammar H, Filipsson Nyström H, Wedell A, Thorén M (2011) Cardiovascular risk, metabolic profile, and body composition in adult males with congenital adrenal hyperplasia due to 21-hydroxylase deficiency. Eur J Endocrinol 164(2):285–293

    Article  PubMed  CAS  Google Scholar 

  47. Botero D, Arango A, Danon M, Lifshitz F (2000) Lipid profile in congenital adrenal hyperplasia. Metabolism 49:790–793

    Article  PubMed  CAS  Google Scholar 

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Conflict of interest

The authors declare that they have no conflict of interest.

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Authors and Affiliations

  1. Paediatrics Department, Ain Shams University, Cairo, Egypt

    N. H. Amr & A. Y. Ahmed

  2. Department of Radiology, Ain Shams University, Cairo, Egypt

    Y. A. Ibrahim

  3. 10 El-Zahraa St., Dokki, Cairo, 12311, Egypt

    N. H. Amr

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  1. N. H. Amr
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Correspondence to N. H. Amr.

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Amr, N.H., Ahmed, A.Y. & Ibrahim, Y.A. Carotid intima media thickness and other cardiovascular risk factors in children with congenital adrenal hyperplasia. J Endocrinol Invest 37, 1001–1008 (2014). https://doi.org/10.1007/s40618-014-0148-8

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  • DOI: https://doi.org/10.1007/s40618-014-0148-8

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