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Effect of androgen excess and glucocorticoid exposure on metabolic risk profiles in patients with congenital adrenal hyperplasia due to 21-hydroxylase deficiency
- Source :
- The Journal of Steroid Biochemistry and Molecular Biology. 197:105540
- Publication Year :
- 2020
- Publisher :
- Elsevier BV, 2020.
-
Abstract
- Data on cardiovascular morbidity in adults with congenital adrenal hyperplasia (CAH) is sparse. We therefore aimed to determine the role of androgen control and glucocorticoid therapy on metabolic health. For that purpose, we included 90 patients (N = 39 men, N = 51 women) with classic CAH due to 21-hydroxylase deficiency (N = 61 salt wasting, N = 29 simple virilizing) and an equal number of controls matched for age, sex, BMI and smoking-habits. We could show that there was no difference in intima-media-thickness between patients and controls and only one patient fulfilled all criteria of the metabolic syndrome. CAH men presented with an increased relative body fat mass in comparison to controls (25.6 % vs. 22.1 %; p = 0.011) while this was not true for CAH women. Body fat was lower in those taking hydrocortisone instead of synthetic glucocorticoids (B = -3.27; p = 0.048). While arterial hypertension was rare, 54 % of patients had an impaired systolic drop at night or were classified as non-dippers (17 %). Impaired dipping was not associated with evening glucocorticoid and fludrocortisone intake but mediated by sodium levels. Insulin resistance was more common in CAH women (B = 1.689; p = 0.036) and in those with poor androgen control (B = 0.823; p = 0.046). In summary, we could show that good cardiovascular health outcome in adult CAH patients can be achieved. Hydrocortisone is superior in terms of body composition. It is yet unclear how non-dipping will translate into cardiovascular morbidity in the long-term.
- Subjects :
- Adult
Male
0301 basic medicine
medicine.medical_specialty
Adolescent
Endocrinology, Diabetes and Metabolism
Fludrocortisone
Clinical Biochemistry
Androgen Excess
Biochemistry
Cohort Studies
Young Adult
03 medical and health sciences
0302 clinical medicine
Endocrinology
Insulin resistance
Congenital adrenal hyperplasia due to 21-hydroxylase deficiency
Risk Factors
Internal medicine
Humans
Medicine
Congenital adrenal hyperplasia
Glucocorticoids
Molecular Biology
Hydrocortisone
Metabolic Syndrome
Adrenal Hyperplasia, Congenital
business.industry
Cell Biology
Middle Aged
medicine.disease
030104 developmental biology
Case-Control Studies
030220 oncology & carcinogenesis
Androgens
Molecular Medicine
Female
Metabolic syndrome
business
Pseudogenes
Glucocorticoid
medicine.drug
Subjects
Details
- ISSN :
- 09600760
- Volume :
- 197
- Database :
- OpenAIRE
- Journal :
- The Journal of Steroid Biochemistry and Molecular Biology
- Accession number :
- edsair.doi.dedup.....eeddebfd898f628226ad17524f777323