Korcan DEMİR, Gönül ÇATLI, Ayhan ABACI, Hale TUHAN, Bumin DÜNDAR, Sezer ACAR, Ece BÖBER, Tülay ÖZTÜRK, Tuğba EGELİ, Şule CAN, Handan GÜLERYÜZ

The relationship of carotid intima-media thickness with anthropometric and metabolic parameters in patients with classic congenital adrenal hyperplasia

Background/aim: We aimed to determine the presence of subclinical atherosclerosis using carotid intima-media thickness (CIMT) and biochemical parameters in children and adolescents with congenital adrenal hyperplasia (CAH). Materials and methods: Thirty-four patients with classic congenital adrenal hyperplasia due to 21-hydroxylase deficiency on regular glucocorticoid treatment for ≥3 years and 31 healthy subjects were included in the study. The patients were divided into two groups according to the degree of control of the clinic, laboratory, and radiological parameters as a) “uncontrolled” [n= 22; with increased height velocity (HV) standard deviation score (SDS) (≥2 SDS), advanced bone age, serum 17-OH progesterone 0.05]. In addition, CIMT levels were similar according to sex and disease control status. Conclusion: In this study, the CIMT values of CAH cases were similar to those of healthy subjects.Key words: Congenital adrenal hyperplasia, carotid intima-media thickness, subclinical atherosclerosis

PDF

___

1. Speiser PW, Azziz R, Baskin LS, Ghizzoni L, Hensle TW et al. Congenital adrenal hyperplasia due to steroid 21-hydroxylase deficiency: an Endocrine Society clinical practice guideline. The Journal of Clinical Endocrinology & Metabolism 2010; 95(9): 4133-4160. doi: 10.1210/jc.2018-01865
2. Parsa AA, New MI. Steroid 21-hydroxylase deficiency in congenital adrenal hyperplasia. The Journal of Steroid Biochemistry and Molecular Biology 2017; 165(Pt A): 2-11. doi: 10.1016/j.jsbmb.2016.06.015
3. Concolino P, Costella A. Congenital adrenal hyperplasia (CAH) due to 21-hydroxylase deficiency: a comprehensive focus on 233 pathogenic variants of CYP21A2 gene. Molecular Diagnosis & Therapy 2018; 22(3): 261-280. doi: 10.1007/ s40291-018-0319-y
4. Roche EF, Charmandari E, Dattani MT, Hindmarsh PC. Blood pressure in children and adolescents with congenital adrenal hyperplasia (21-hydroxylase deficiency): a preliminary report. Clinical Endocrinology 2003; 58(5): 589-596. doi: 10.1046/j.1365-2265.2003.01757.x
5. Volkl TM, Simm D, Beier C, Dorr HG. Obesity among children and adolescents with classic congenital adrenal hyperplasia due to 21-hydroxylase deficiency. Pediatrics 2006; 117(1): e98- 105. doi: 10.1542/peds.2005-1005
6. Charmandari E, Chrousos GP. Metabolic syndrome manifestations in classic congenital adrenal hyperplasia: do they predispose to atherosclerotic cardiovascular disease and secondary polycystic ovary syndrome? Annals of the New York Academy of Sciences 2006; 1083: 37-53. doi: 10.1196/ annals.1367.005
7. Magge SN, Goodman E, Armstrong SC, Committee On N, Section On E et al. The metabolic syndrome in children and adolescents: shifting the focus to cardiometabolic risk factor clustering. Pediatrics 2017; 140(2). doi: 10.1542/peds.2017- 1603
8. Bots ML, Hoes AW, Koudstaal PJ, Hofman A, Grobbee DE. Common carotid intima-media thickness and risk of stroke and myocardial infarction: the Rotterdam Study. Circulation 1997; 96(5): 1432-1437. doi: 10.1161/01.cir.96.5.1432
9. Jarvisalo MJ, Raitakari M, Toikka JO, Putto-Laurila A, Rontu R et al. Endothelial dysfunction and increased arterial intima-media thickness in children with type 1 diabetes. Circulation 2004; 109(14): 1750-1755. doi: 10.1161/01. CIR.0000124725.46165.2C
10. Pena AS, Wiltshire E, MacKenzie K, Gent R, Piotto L et al. Vascular endothelial and smooth muscle function relates to body mass index and glucose in obese and nonobese children. The Journal of Clinical Endocrinology & Metabolism 2006; 91(11): 4467-4471. doi: 10.1210/jc.2006-0863
11. Akyurek N, Atabek ME, Eklioglu BS, Alp H. Ambulatory blood pressure and subclinical cardiovascular disease in patients with congenital adrenal hyperplasia: a preliminary report. Journal of Clinical Research in Pediatric Endocrinology 2015; 7(1): 13- 18. doi: 10.4274/jcrpe.1658
12. Amr NH, Ahmed AY, Ibrahim YA. Carotid intima media thickness and other cardiovascular risk factors in children with congenital adrenal hyperplasia. Journal of Endocrinological Investigation 2014; 37(10): 1001-1008. doi: 10.1007/s40618-014- 0148-8
13. Kim MS, Dao-Tran A, Davidowitz E, Tseng T, Gilsanz V et al. Carotid intima-media thickness is associated with increased androgens in adolescents and young adults with classical congenital adrenal hyperplasia. Hormone Research in Paediatrics 2016; 85(4): 242-249. doi: 10.1159/000444169
14. Ozkan F, Ozel D, Ozel BD. Obtaining accurate measurement of carotid intima-media thickness in children with classic congenital adrenal hyperplasia. The European Journal of Pediatrics 2016; 175(3): 413-414. doi: 10.1007/s00431-015-2677-3
15. Rodrigues TM, Barra CB, Santos JL, Goulart EM, Ferreira AV et al. Cardiovascular risk factors and increased carotid intimamedia thickness in young patients with congenital adrenal hyperplasia due to 21-hydroxylase deficiency. Archives of Endocrinology and Metabolism 2015; 59(6): 541-547. doi: 10.1590/2359-3997000000119
16. Tuhan H, Demircan T, Altincik A, Catli G, Kizilca O et al. Impaired systolic and diastolic left ventricular function in children and adolescents with congenital adrenal hyperplasia receiving corticosteroid therapy. Cardiology in the Young 2019; 29(3): 319-324. doi: 10.1017/S1047951118002330
17. Neyzi O, Bundak R, Gokcay G, Gunoz H, Furman A et al. Reference values for weight, height, head circumference, and body mass index in turkish children. Journal of Clinical Research in Pediatric Endocrinology 2015; 7(4): 280-293. doi: 10.4274/ jcrpe.2183
18. Demir K, Konakci E, Ozkaya G, Kasap Demir B, Ozen S et al. New features for child metrics: further growth references and blood pressure calculations. Journal of Clinical Research in Pediatric Endocrinology 2020; 12(2): 125-129. doi: 10.4274/ jcrpe.galenos.2019.2019.0127
19. Harrington J, Pena AS, Gent R, Hirte C, Couper J. Adolescents with congenital adrenal hyperplasia because of 21-hydroxylase deficiency have vascular dysfunction. Clinical Endocrinology 2012; 76(6): 837-842. doi: 10.1111/j.1365-2265.2011.04309.x
20. Sibal L, Agarwal SC, Home PD. Carotid intima-media thickness as a surrogate marker of cardiovascular disease in diabetes. Diabetes, Metabolic Syndrome and Obesity 2011; 4: 23-34. doi: 10.2147/DMSO.S8540
21. Mooij CF, Kroese JM, Claahsen-van der Grinten HL, Tack CJ, Hermus AR. Unfavourable trends in cardiovascular and metabolic risk in paediatric and adult patients with congenital adrenal hyperplasia? Clinical Endocrinology 2010; 73(2): 137- 146. doi: 10.1111/j.1365-2265.2009.03690.x
22. Metwalley KA, Farghaly HS, Sherief T. Left ventricular dysfunction and subclinical atherosclerosis in children with classic congenital adrenal hyperplasia: a single-center study from upper Egypt. The European Journal of Pediatrics 2016; 175(3): 405-412. doi: 10.1007/s00431-015-2634-1
23. Mnif MF, Kamoun M, Mnif F, Charfi N, Naceur BB et al. Metabolic profile and cardiovascular risk factors in adult patients with congenital adrenal hyperplasia due to 21-hydroxylase deficiency. The Indian Journal of Endocrinology and Metabolism 2012; 16(6): 939- 946. doi: 10.4103/2230-8210.102995
24. Ozdemir R, Korkmaz HA, Kucuk M, Karadeniz C, Mese T et al. Assessment of early atherosclerosis and left ventricular dysfunction in children with 21-hydroxylase deficiency. Clinical Endocrinology 2017; 86(4): 473-479. doi: 10.1111/ cen.13275
25. Sartorato P, Zulian E, Benedini S, Mariniello B, Schiavi F et al. 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. The Journal of Clinical Endocrinology & Metabolism 2007; 92(3): 1015-1018. doi: 10.1210/jc.2006-1711
26. Muthusamy K, Elamin MB, Smushkin G, Murad MH, Lampropulos JF et al. Clinical review: Adult height in patients with congenital adrenal hyperplasia: a systematic review and metaanalysis. The Journal of Clinical Endocrinology & Metabolism 2010; 95(9): 4161-4172. doi: 10.1210/jc.2009-2616
27. Savva SC, Tornaritis M, Savva ME, Kourides Y, Panagi A et al. Waist circumference and waist-to-height ratio are better predictors of cardiovascular disease risk factors in children than body mass index. International Journal of Obesity and Related Metabolic Disorders 2000; 24(11): 1453-1458. doi: 10.1038/sj.ijo.0801401
28. Ubertini G, Bizzarri C, Grossi A, Gimigliano F, Rava L et al. Blood pressure and left ventricular characteristics in young patients with classical congenital adrenal hyperplasia due to 21-hydroxylase deficiency. International Journal of Pediatric Endocrinology 2009; 2009: 383610. doi: 10.1155/2009/383610
29. Hoepffner W, Herrmann A, Willgerodt H, Keller E. Blood pressure in patients with congenital adrenal hyperplasia due to 21-hydroxylase deficiency. Journal of Pediatric Endocrinology and Metabolism 2006; 19(5): 705-711. doi: 10.1515/jpem.2006.19.5.705
30. de Silva KS, Kanumakala S, Brown JJ, Jones CL, Warne GL. 24-hour ambulatory blood pressure profile in patients with congenital adrenal hyperplasia--a preliminary report. Journal of Pediatric Endocrinology and Metabolism 2004; 17(8): 1089- 1095. doi: 10.1515/jpem.2004.17.8.1089
31. Volkl TM, Simm D, Dotsch J, Rascher W, Dorr HG. Altered 24-hour blood pressure profiles in children and adolescents with classical congenital adrenal hyperplasia due to 21-hydroxylase deficiency. The Journal of Clinical Endocrinology & Metabolism 2006; 91(12): 4888-4895. doi: 10.1210/jc.2006-1069
32. Marra AM, Improda N, Capalbo D, Salzano A, Arcopinto M et al. Cardiovascular abnormalities and impaired exercise performance in adolescents with congenital adrenal hyperplasia. The Journal of Clinical Endocrinology & Metabolism 2015; 100(2): 644-652. doi: 10.1210/jc.2014-1805
33. Bachelot A, Plu-Bureau G, Thibaud E, Laborde K, Pinto G et al. Long-term outcome of patients with congenital adrenal hyperplasia due to 21-hydroxylase deficiency. Hormone Research 2007; 67(6): 268-276. doi: 10.1530/EJE-11-0789
34. Falhammar H, Filipsson H, Holmdahl G, Janson PO, Nordenskjold A et al. Metabolic profile and body composition in adult women with congenital adrenal hyperplasia due to 21-hydroxylase deficiency. The Journal of Clinical Endocrinology & Metabolism 2007; 92(1): 110-116. doi: 10.1210/jc.2006-1350
35. Falhammar H, Filipsson Nystrom H, Wedell A, Thoren M. Cardiovascular risk, metabolic profile, and body composition in adult males with congenital adrenal hyperplasia due to 21-hydroxylase deficiency. European Journal of Endocrinology 2011; 164(2): 285-293. doi: 10.1210/jc.2006-1350
36. Botero D, Arango A, Danon M, Lifshitz F. Lipid profile in congenital adrenal hyperplasia. Metabolism 2000; 49(6): 790- 793. doi: 10.1210/jc.2014-1486
37. Zimmermann A, Grigorescu-Sido P, AlKhzouz C, Patberg K, Bucerzan S et al. Alterations in lipid and carbohydrate metabolism in patients with classic congenital adrenal hyperplasia due to 21-hydroxylase deficiency. Hormone Research in Paediatrics 2010; 74(1): 41-49. doi: 10.1159/000313368
38. Mohammadifard N, Nazem M, Sarrafzadegan N, Nouri F, Sajjadi F et al. Body mass index, waist-circumference and cardiovascular disease risk factors in Iranian adults: Isfahan healthy heart program. Journal of Health, Population, and Nutrition 2013; 31(3): 388-397. doi: 10.3329/jhpn.v31i3.16831
39. Keevil B. Steroid Mass Spectrometry for the Diagnosis of PCOS. Medical Sciences 2019; 7(7). doi: 10.3390/medsci7070078