CEDIE   05498
CENTRO DE INVESTIGACIONES ENDOCRINOLOGICAS "DR. CESAR BERGADA"
Unidad Ejecutora - UE
congresos y reuniones científicas
Título:
Blood Pressure Profiles, Cardiovascular Risk, and Renal Handling During an Oral Sodium Load Test in Adolescents and Young Adults with Congenital Adrenal Hyperplasia (CAH) due to 21-Hydroxylase Deficiency
Autor/es:
FINKIELSTAIN, G.P.; SIMSOLO, R.; ROMO, M.; QUILINDRO, A.; COZZANI, H.; BALLERINI, M.G.; GRIPPO, M.; GRUNFELD, B; BERGADÁ, I
Lugar:
Playa del Carmen
Reunión:
Congreso; XXIV Reuniòn de la Sociedad Latinoamericana de Endocrinología Pediátrica; 2014
Resumen:
Introduction: Long term glucocorticoid and mineralocorticoid treatment in patients with congenital adrenal hyperplasia (CAH) might increase the risk of cardiovascular disease. However, whether these consequences occur early in adolescents and young adults remain controversial. Aim: To assess cardiovascular risk and renal handling throughout an oral sodium load test in adolescents and young adults with salt wasting (SW) and simple virilizing (SV) CAH due to 21-hydroxylase deficiency. Patients and Methods: Cohort study. Patients with CAH regularly followed, through an exhausted clinical (height, BMI) and biochemical assessment, (17OHP, Androstenedione, total testosterone, plasma renin activity (PRA), glucose, insulin) from 2010 to 2013 and a healthy control group were enrolled (Tanner stage 5, age ≤28 years). CAH patients received mean equivalent hydrocortisone doses of 14.5±2.4 mg/m2 and 9α-fludrocortisone doses for patients with SW-CAH was 0.09±0.02 mg/d. Cardiovascular evaluation included ambulatory blood pressure measurement (ABPM), color Doppler echocardiography and intima media thickness (IMT) measurements by carotid Doppler ultrasonography before a 3-day oral sodium load test (NaCl 10 gr/d). Physiological nocturnal dip in blood pressure was defined as ≥10% difference between day-time and night-time BP. Subjects suffering from renal or cardiac disorders and history of hypertension were excluded (n = 2). One CAH patient with poor hormonal control was excluded from the salt load test. Fisher exact text, t-test and ANCOVA using BMI as covariate were used as appropriate. Results: 19 CAH patients (15 SW, 4SV) (5 males) aged 14.6? 28.0 yr and 11 controls (6 males) aged 17.1?26 yr were included. Height SDS was significantly lower in CAH patients than controls (?0.83±0.28 SDS vs 0.60±0.21 SDS; p = 0.001) while a higher BMI SDS (1.04±0.19 vs 0.43±0.13, P = 0.03), fasting insulin levels (17.5±2.1 vs 6.6±0.55, P = 0.0006) and HOMA-IR (3.4±0.3 vs 1.4±0.1, P = 0.002) was observed in CAH group as compared to controls. Day-time (systolic 120.4±3.3 vs 121.1±1.9, diastolic 71.6±1.5 vs 70.5±1.8 mm Hg) and night-time (systolic 108.0±1.3 vs 108.8±1.1, diastolic 59.8±1.7 vs 58.4±1.5 mm Hg) BP were not significantly different between patients and controls. The proportion of absent physiological nocturnal dip in BP was significantly higher in the CAH group than in controls (68% vs 32%, respectively); Fisher?s exact Test P < 0.0001. Doppler echocardiography showed normal ventricular function and absence of left ventricular hypertrophy (LVH) in both groups. Doppler ultrasonography showed increased IMT (0.8 mm) at different sites of the left and right carotid artery in 2/18 CAH patients and in 1/11 controls. No significant difference in total sodium excretion was found between the CAH and control groups throughout the study period (B: 161.8±20.7 vs 148.5±22.6 mEq/d; Post: 269.0±21.6 vs 254.6±25.6 mEq/day). Baseline and post PRA was significantly higher in CAH patients (B: 9.9±1.9 vs 3.6±0.8 ng/ ml/h, P = 0.009; Post 6.4±1.2 vs 0.70±0.1 ng/ml/h, P = 0.0004) compared to controls. Conclusions: Adolescents and young adults with CAH have higher insulin and HOMA-IR levels than controls in spite of BMI correction. CAH cohort did not show overt signs of high BP and early cardiovascular disease, however, a high significant proportion of patients in this group had a non-dipping pattern and also a persistence of high PRA after a salt loading test compared to controls. These findings might be additional risk factors for cardiovascular morbidity. Therefore, we suggest including these cardiovascular markers in the regular management of CAH patients.