Health Status of Adults with Congenital Adrenal Hyperplasia: A Cohort Study of 203 Patients

Autor: Debbie S. Willis, Paul V. Carroll, John M. C. Connell, Thang S. Han, Nils Krone, G. S. Conway, Sarah H. Wild, Emma J. Doherty, Stefanie Hahner, D. Aled Rees, Richard J. Ross, Roland H Stimson, Brian R. Walker, Wiebke Arlt
Jazyk: angličtina
Rok vydání: 2010
Předmět:
Male
Health Status
Endocrinology
Diabetes and Metabolism
Clinical Biochemistry
Biochemistry
Body Mass Index
0302 clinical medicine
Endocrinology
Congenital adrenal hyperplasia due to 21-hydroxylase deficiency
Prospective Studies
Prospective cohort study
2. Zero hunger
Health Survey for England
Middle Aged
3. Good health
030220 oncology & carcinogenesis
Body Composition
RC Internal medicine
Prednisolone
Original Article
Female
medicine.drug
Cohort study
Adult
medicine.medical_specialty
Adolescent
Hypercholesterolemia
030209 endocrinology & metabolism
03 medical and health sciences
Internal medicine
medicine
Endocrine Research
Humans
Congenital adrenal hyperplasia
Obesity
Glucocorticoids
Aged
Hydrocortisone
Adrenal Hyperplasia
Congenital
business.industry
Biochemistry (medical)
medicine.disease
United Kingdom
Cross-Sectional Studies
RA Public aspects of medicine
Osteoporosis
Insulin Resistance
business
Body mass index
Zdroj: Arlt, W, Willis, D S, Wild, S H, Krone, N, Doherty, E J, Hahner, S, Han, T S, Carroll, P V, Conway, G S, Rees, D A, Stimson, R H, Walker, B R & Connell, J M C & Ross, R J 2010, ' Health Status of Adults with Congenital Adrenal Hyperplasia: A Cohort Study of 203 Patients ', Journal of Clinical Endocrinology & Metabolism, vol. 95, no. 11, pp. 5110-5121 . https://doi.org/10.1210/jc.2010-0917
The Journal of Clinical Endocrinology and Metabolism
DOI: 10.1210/jc.2010-0917
Popis: Context: No consensus exists for management of adults with congenital adrenal hyperplasia (CAH) due to a paucity of data from cohorts of meaningful size. Objective: Our objective was to establish the health status of adults with CAH. Design and Setting: We conducted a prospective cross-sectional study of adults with CAH attending specialized endocrine centers across the United Kingdom. Patients: Participants included 203 CAH patients (199 with 21-hydroxylase deficiency): 138 women, 65 men, median age 34 (range 18–69) years. Main Outcome Measures: Anthropometric, metabolic, and subjective health status was evaluated. Anthropometric measurements were compared with Health Survey for England data, and psychometric data were compared with appropriate reference cohorts. Results: Glucocorticoid treatment consisted of hydrocortisone (26%), prednisolone (43%), dexamethasone (19%), or a combination (10%), with reverse circadian administration in 41% of patients. Control of androgens was highly variable with a normal serum androstenedione found in only 36% of patients, whereas 38% had suppressed levels suggesting glucocorticoid overtreatment. In comparison with Health Survey for England participants, CAH patients were significantly shorter and had a higher body mass index, and women with classic CAH had increased diastolic blood pressure. Metabolic abnormalities were common, including obesity (41%), hypercholesterolemia (46%), insulin resistance (29%), osteopenia (40%), and osteoporosis (7%). Subjective health status was significantly impaired and fertility compromised. Conclusions: Currently, a minority of adult United Kingdom CAH patients appear to be under endocrine specialist care. In the patients studied, glucocorticoid replacement was generally nonphysiological, and androgen levels were poorly controlled. This was associated with an adverse metabolic profile and impaired fertility and quality of life. Improvements in the clinical management of adults with CAH are required.
Adult patients with congenital adrenal hyperplasia (CAH) have poor subjective health status and only a minority of CAH adults receives regular review by endocrine specialists.
Databáze: OpenAIRE
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