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

Sartorato, Paola; Zulian, E.; Benedini, Stefano; Mariniello, Barbara; Schiavi, Francesca; Bilora, Franca; Pozzan, Giovanni Battista; Greggio, Nella Augusta; Pagnan, Antonio; Mantero, Franco; Scaroni, Carla

doi:10.1210/jc.2006-1711

Cited by 118 publications

(146 citation statements)

References 16 publications

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“…Single blood pressure measurements in adult CAH, mainly in females, have found values similar to controls (20,21) or elevated (23). No differences from controls were found by us in 24 h ambulatory measurements with the exception of one genotype group (see below).…”

Section: Discussionsupporting

confidence: 55%

“…Our patients had increased insulin release during the OGTT and older patients tended to have higher HbA1c than younger ones, suggesting an increased risk of T2DM in the older CAH males. Insulin resistance has been found in adult CAH by all investigators (6,8,9,12,13,18,(20)(21)(22)(23), but one (18) and has most commonly been expressed as homeostasis model assessment (HOMA) index. We did not calculate this index because fasting glucose was low in our patients, which may lead to a falsely low estimation of insulin resistance.…”

Section: Discussionmentioning

confidence: 99%

“…The data were divided into the subgroups aged !30 years or older to allow comparisons with previous studies that had mainly included males below 30 years (9,14,16,17,19,21). Moreover, pediatric endocrinology was introduced in Sweden about 30 years before the inclusion of the present cohort, which could affect outcomes.…”

Section: Subjectsmentioning

confidence: 99%

“…Inadequate mineralocorticoid therapy for aldosterone deficiency may also have negative impact on the vascular system (11). Previous reports on cardiovascular and metabolic profiles in CAH adults have mainly included young females, in spite of the fact that males in general have a higher cardiovascular risk, and the results have been contradictory (6,8,9,(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22). A very recent publication described however a cohort of 203 individuals with CAH including 62 males reporting adverse metabolic profiles (23).…”

Section: Introductionmentioning

confidence: 99%

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Cardiovascular risk, metabolic profile, and body composition in adult males with congenital adrenal hyperplasia due to 21-hydroxylase deficiency

Falhammar¹,

Nyström²,

Wedell³

et al. 2011

European Journal of Endocrinology

105

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Objective: Lifelong glucocorticoid therapy in patients with congenital adrenal hyperplasia (CAH) or the disease per se may result in increased cardiovascular risk. We therefore investigated cardiovascular and metabolic risk profiles in adult CAH males. Subjects and methods: We compared CAH males (nZ30), 19-67 years old, with age-and sex-matched controls (nZ32). Subgroups of different ages (!30 years or older) and CYP21A2 genotypes (null, I2splice, and I172N as the mildest mutation) were studied. Anthropometry, fat and lean mass measured by dual-energy X-ray absorptiometry, lipids, liver function tests, homocysteine, lipoprotein-(a), glucose and insulin during an oral glucose tolerance test (OGTT), urine albumin, adrenal hormones, and 24 h ambulatory blood pressure measurements were studied. Results: CAH males were shorter. Waist/hip ratio and fat mass were higher in older patients and the I172N group. Heart rate was faster in older patients, the I2splice, and I172N groups. Insulin levels were increased during OGTT in all patients and in the I172N group. g-glutamyl transpeptidase was increased in older patients and in the I172N group. Testosterone was lower in older patients. Homocysteine was lower in younger patients, which may be cardioprotective. The cardiovascular risk seemed higher with hydrocortisone/cortisone acetate than prednisolone. Urinary epinephrine was lower in all groups of patients except in I172N. Conclusions: Indications of increased risk were found in CAH males R30 years old and in the I172N group. In contrast, younger CAH males did not differ from age-matched controls. This is likely to reflect a better management in recent years.

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Section: Discussionsupporting

confidence: 55%

Section: Discussionmentioning

confidence: 99%

Section: Subjectsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Cardiovascular risk, metabolic profile, and body composition in adult males with congenital adrenal hyperplasia due to 21-hydroxylase deficiency

Falhammar¹,

Nyström²,

Wedell³

et al. 2011

European Journal of Endocrinology

105

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“…Of the few studies that have explored insulin sensitivity in CAH, most have concluded that CAH patients are indeed characterized by insulin resistance (5)(6)(7)(8)(9)(10)(11). Many different methods have been used to assess insulin sensitivity, but studies using the euglycemic hyperinsulinemic clamp method, the gold standard to assess insulin sensitivity, are lacking.…”

Section: Introductionmentioning

confidence: 99%

Pioglitazone improves insulin resistance and decreases blood pressure in adult patients with congenital adrenal hyperplasia

Kroese

Mooij

Hermus³

et al. 2009

European Journal of Endocrinology

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Context: Patients with congenital adrenal hyperplasia (CAH) are chronically treated with supraphysiological doses of glucocorticoids, which are known to induce insulin resistance. Thiazolidinediones might reverse this effect and improve insulin sensitivity. Objectives: To assess insulin sensitivity in CAH patients and the effect of pioglitazone treatment on insulin sensitivity in CAH patients. Secondary objectives were the effects of treatment with pioglitazone on blood pressure, body fat distribution, lipid, and steroid profiles. Design: Randomized placebo controlled crossover trial. Participants: Twelve CAH patients and 12 body mass and age-matched control subjects. Intervention: Sixteen-week treatment with pioglitazone (45 mg/day) or placebo. Main outcome measure: Insulin sensitivity measured by euglycemic clamp and oral glucose tolerance test. Further measures were 24-h blood pressure profiles, body fat distribution measured by magnetic resonance imaging, dual energy x-ray absorptiometry (DEXA) and bioimpedance procedures, liver fat by magnetic resonance spectroscopy, lipid, and steroid profiles. Results: CAH patients were insulin resistant compared with healthy controls. Treatment with pioglitazone significantly improved insulin sensitivity in CAH patients (glucose infusion rate (GIR) from 28.5G11.6 to 38.9G11.0 mmol/kg per min, PZ0.000, GIR in controls 46.2G23.4 mmol/kg per min, P!0.05 versus CAH). Treatment with pioglitazone decreased blood pressure (systolic: 124.0G13.6 vs 127.0G14.9 mmHg, P!0.001, diastolic: 72.8G11.5 vs 77.4G12.6 mmHg, P!0.001). No changes in body fat distribution, lipid, and steroid profiles were observed. Conclusions: CAH patients are insulin resistant compared with matched control subjects. Treatment with pioglitazone improves insulin sensitivity and decreases blood pressure in CAH patients.

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Vascular Ultrasound Imaging in Children

Tierney

Singh

2009

Echocardiography in Pediatric and Congenital Heart Disease

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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

Abstract: A reduced insulin sensitivity and increased IMT were demonstrated in adults with CAH, who consequently need a follow-up for cardiovascular risk.

Cited by 118 publications

References 16 publications

Cardiovascular risk, metabolic profile, and body composition in adult males with congenital adrenal hyperplasia due to 21-hydroxylase deficiency

Cardiovascular risk, metabolic profile, and body composition in adult males with congenital adrenal hyperplasia due to 21-hydroxylase deficiency

Pioglitazone improves insulin resistance and decreases blood pressure in adult patients with congenital adrenal hyperplasia

Vascular Ultrasound Imaging in Children

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