Obesity and Familial Predisposition Are Significant Determining Factors of an Adverse Metabolic Profile in Young Patients with Congenital Adrenal Hyperplasia

Moreira, Ricardo P. P.; Villares, S M; Madureira, Guiomar; Mendonca, Berenice B.; Bachega, Tânia A. S. S.

doi:10.1159/000353762

Cited by 18 publications

(16 citation statements)

References 42 publications

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“…Our longitudinal study's findings of increased overweight and obesity in children with CAH is consistent with high BMI percentiles found by some prior cross‐sectional studies but differs from others which did not find increased BMI percentiles . However, none of these studies examined differences in obesity status at different age intervals or used BMI‐for height‐age effects, independent of BMI‐for‐age ranking.…”

Section: Discussionsupporting

confidence: 87%

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Obesity in children with congenital adrenal hyperplasia in the Minnesota cohort: importance of adjusting body mass index for height‐age

Sarafoglou

Forlenza

Addo

et al. 2017

Clinical Endocrinology

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Summary Objectives To evaluate obesity and overweight in children with congenital adrenal hyperplasia (CAH) and associations with glucocorticoids, fludrocortisone and disease control. Adjusting body mass index-for-height-age (BMIHA) percentile is proposed to correct misclassification of obese/overweight status in CAH children with advanced bone age and tall-for-age stature. Design Longitudinal. Patients One hundred and ninety-four children with CAH seen from 1970 to 2013: 124 salt wasting (SW); 70 simple virilizing (SV); 102 females. Measurements Body mass index (BMI) end-points were overweight (85–94 percentile) and obese (≥95 percentile). Results Approximately 50% of the children had at least one BMI measurement ≥95 percentile and about 70% had at least one ≥85 percentile. Using BMIHA percentiles, obesity incidence decreased slightly in SW children (47–43%) and markedly in SV children (50–33%); however, overweight status was not reduced. Only 6% of SW and 1% of SV children were persistently obese (≥3 clinic visits) when BMIHA was applied, whereas overweight status persisted in 35% of SW and 33% of SV children. Most obesity or overweight when using BMIHA occurred before age 10 and there was no association with hydrocortisone (HC) or fludrocortisone dosing. Adiposity rebound for SW children occurred by 3.3 years and in SV females by age 3.8 years, over a year earlier than the adiposity rebound for healthy children. Conclusion Children with CAH are at higher risk for early onset obesity and overweight with or without using BMIHA but rates of persistent obesity were lower than previously reported. Careful HC dosing during early childhood is needed to prevent increased weight gain and an early adiposity rebound.

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Section: Discussionsupporting

confidence: 87%

“…Body composition of children with CAH is an emerging area of focus, and recent data indicate that body mass index (BMI) and/or fat mass is elevated in children and adults with CAH . In normal growth, BMI increases rapidly in infancy and peaks at around the first year of life.…”

Section: Introductionmentioning

confidence: 99%

Obesity in children with congenital adrenal hyperplasia in the Minnesota cohort: importance of adjusting body mass index for height‐age

Sarafoglou

Forlenza

Addo

et al. 2017

Clinical Endocrinology

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“…Medes-dos-Santos et al (2011) concluded in their cross sectional, retrospective study that height in these children was similar to unaffected children of the same age, yet children with CAH had higher body fat, which tended to be visceral. Similarly, Moreira et al (2013) found that children with CAH presented with a higher prevalence of obesity and metabolic syndrome, but child weight was not correlated with glucocorticoid treatment. Cetinkaya and Kara evaluated the effects of glucocorticoid doses on bone mineral density in their 2011 study and found that children with CAH had higher BMIs than controls.…”

Section: Resultsmentioning

confidence: 95%

“…Obesity was found to be a significant problem in children with CAH (Volkl, Simm, Beier, & Dorr, 2006; Mendes-dos-Santos et. al, 2011; Cetinkaya & Kara, 2011; Moreira et al, 2013). Medes-dos-Santos et al (2011) concluded in their cross sectional, retrospective study that height in these children was similar to unaffected children of the same age, yet children with CAH had higher body fat, which tended to be visceral.…”

Section: Resultsmentioning

confidence: 99%

Management of Childhood Congenital Adrenal Hyperplasia—An Integrative Review of the Literature

Fleming¹,

Riper²,

Knafl³

2017

Journal of Pediatric Health Care

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Congenital adrenal hyperplasia (CAH) is an endocrine condition that requires parents to administer steroids up to three times daily, supplementing maintenance doses with oral or injectable doses during times of illness. The purpose of this integrative review was to explore the management, care and associated health issues for children with CAH as well as the family response to the condition. Four literature indexes were searched with 39 articles included. Four themes emerged: 1) health and development related issues; 2) effects of excess androgens; 3) life experience of CAH; and 4) managing and averting adrenal crisis. Families having a child with CAH face complex concerns related their child’s growth, the fear of adrenal crisis events, and the consequences of atypical genitalia for affected girls. Future studies should focus on interventions that provide guidelines to increase parental preparedness in managing adrenal crises as well as creating support systems for affected girls.

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“…Glucocorticoid dose, advanced maturation of the bone age and parental obesity contribute to increased BMI-SD score (SDS) in children and adolescents with CAH 27 28. An early ‘adiposity rebound’, defined as the age at which the physiological decrease in BMI reverses, has also been described in children with CAH 29.…”

Section: Cardiovascular and Metabolic Risk Profile In Children And Yomentioning

confidence: 99%

Cardiovascular health, growth and gonadal function in children and adolescents with congenital adrenal hyperplasia

et al. 2016

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After the introduction of replacement therapy with glucocorticoids and mineralocorticoids in the 1950s, congenital adrenal hyperplasia (CAH) is no longer a life-limiting condition. However, due to the successful introduction of medical steroid hormone replacement, CAH has become a chronic condition, with associated comorbidities and long-term health implications. The aim of treatment is the replacement of mineralocorticoids and glucocorticoids and the normalisation of elevated androgen concentrations. Long-term consequences of the condition and current treatment regimens include unfavourable changes in the cardiovascular risk profile, impaired growth, testicular adrenal rest tumours (TART) in male and subfertility in both male and female patients with CAH. Optimising replacement therapy in patients with CAH remains challenging. On one hand, treatment with supraphysiological doses of glucocorticoids might be required to normalise androgen concentrations and decrease size or presence of TARTs. On the other hand, treatment with supraphysiological doses of glucocorticoids is associated with an increased prevalence of unfavourable cardiovascular and metabolic risk profiles as well as impaired longitudinal growth and gonadal function. Therefore, treatment of children and adults with CAH requires an individualised approach. Careful monitoring for early signs of complications is already warranted during paediatric healthcare provision to prevent and reduce the impact of comorbidities in later life.

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Obesity and Familial Predisposition Are Significant Determining Factors of an Adverse Metabolic Profile in Young Patients with Congenital Adrenal Hyperplasia

Cited by 18 publications

References 42 publications

Obesity in children with congenital adrenal hyperplasia in the Minnesota cohort: importance of adjusting body mass index for height‐age

Obesity in children with congenital adrenal hyperplasia in the Minnesota cohort: importance of adjusting body mass index for height‐age

Management of Childhood Congenital Adrenal Hyperplasia—An Integrative Review of the Literature

Cardiovascular health, growth and gonadal function in children and adolescents with congenital adrenal hyperplasia

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