Homocysteine Level in Children with Classic Congenital Adrenal Hyperplasia: Relationship to Carotid Intimal Wall Thickness and Left Ventricular Function

Metwalley, Kotb Abbass; Farghaly, Hekma Saad; Abdelhamid, Abdelrahman

doi:10.1159/000492900

Cited by 14 publications

(21 citation statements)

References 31 publications

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“…Regarding the contractile function of the LV, our patients had significant moderate LV systolic dysfunction with lower FS percentages than previously reported, where the mean (SD) LVFS% reported in our patients was 22.93% (13.90) compared to 42.2% (3.1), 37% (4) and nearly 40.67% in studies published by Metwalley et al, 30 Mooij et al 33 and Nengom et al, 41 respectively.…”

Section: Discussioncontrasting

confidence: 48%

Effect of long‐term glucocorticoid therapy on cardiac functions in children with congenital adrenal hyperplasia

Amr

Mahmoud

Youssef

et al. 2020

Clinical Endocrinology

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BackgroundGlucocorticoids play an important role in cardiac physiology. Chronic exposure and higher doses may cause adverse effects on the myocardium, especially in young patients receiving long‐term therapy.ObjectiveTo assess cardiac function in children with congenital adrenal hyperplasia (CAH) and its relation to glucocorticoid dose and therapy duration.MethodsForty‐seven patients with CAH due to 21‐hydroxylase deficiency were compared to 47 controls. Patients were subdivided according to treatment duration (Group A: less than 6 years, Group B: more than 6 years). Mean daily glucocorticoid and cumulative glucocorticoid doses were calculated. Echocardiography was performed for patients and controls to evaluate cardiac functions, chamber dimensions and tissue Doppler valvular status.ResultsCompared to controls, patients had cardiac chamber hypertrophy reflected by higher M‐mode dimensions. Patients had lower fractional shortening, defective ventricular relaxation, lower average mitral and tricuspid e´/a´ ratios (e´ early diastolic, a´ late diastolic) as well as s´ (systolic) velocities, higher average mitral E/e ratio and higher left ventricle TDI Tei index (P < .05). Group B had lower average mitral e´/a´ and tricuspid s´ velocities, and higher average mitral E/e ratio (P < .05). Cumulative glucocorticoid dose significantly correlated with different echocardiographic parameters.ConclusionLong‐term glucocorticoid therapy even within the recommended therapeutic range adversely affects cardiac functions in children with 21‐hydroxylase deficiency.

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Section: Discussioncontrasting

confidence: 48%

Effect of long‐term glucocorticoid therapy on cardiac functions in children with congenital adrenal hyperplasia

Amr

Mahmoud

Youssef

et al. 2020

Clinical Endocrinology

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“…Finally, homocysteine concentrations were also higher than controls (despite comparable folate and vitamin B12 levels), especially in poorly controlled CAH patients aged 5–12 years (50).…”

Section: Non-traditional CV Risk Factorsmentioning

confidence: 99%

Cardiovascular Health in Children and Adolescents With Congenital Adrenal Hyperplasia Due to 21-Hydroxilase Deficiency

Improda¹,

Barbieri²,

Ciccarelli³

et al. 2019

Front. Endocrinol.

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Increasing evidence indicates that adults with Congenital Adrenal Hyperplasia (CAH) may have a cluster of cardiovascular (CV) risk factors. In addition, ongoing research has highlighted that children and adolescents with CAH are also prone to developing unfavorable metabolic changes, such as obesity, hypertension, insulin resistance, and increased intima-media thickness, which places them at a higher risk of developing CV disease in adulthood. Moreover, CAH adolescents may exhibit subclinical left ventricular diastolic dysfunction and impaired exercise performance, with possible negative consequences on their quality of life. The therapeutic management of patients with CAH remains a challenge and current treatment regimens do not always allow optimal biochemical control. Indeed, overexposure to glucocorticoids and mineralocorticoids, as well as to androgen excess, may contribute to the development of unfavorable metabolic and CV abnormalities. Long-term prospective studies on large cohorts of patients will help to clarify the pathophysiology of metabolic alterations associated with CAH. Meanwhile, further efforts should be made to optimize treatment and identify new therapeutic approaches to prevent metabolic derangement and improve long-term health outcomes of CAH patients.

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“…In recent years, research studies have investigated the role of HHcy levels in pediatric cardiovascular diseases, both to determine their relationship with the severity of diseases and to use Hcy as prognostic biomarker for increased risk of cardiovascular diseases. Recently, studies on cardiovascular disease in children and adolescents have examined postural tachycardia syndrome (PoTS) [89], congenital anomalies (congenital adrenal hyperplasia) [90], and heart failure [91]. PoTS is a common functional cardiovascular disease in children and adolescents, representing one of the main causes of syncope in pediatric populations, and it accounts for about 32.2% of all cases [92,93].…”

Section: Hhcy and Cardiovascular Diseasesmentioning

confidence: 99%

“…Hcy can play an important role in modulating PoTS; nevertheless, further studies are needed to clarify how it could be used as an effective index to predict the short-term outcome of PoTS in children. At present, Hcy levels are suspected to play a role in etiology and control of these results in some cardiovascular diseases like PoTS, and some studies have shown that measurement of Hcy in children with acute heart failure (HF) and congenital adrenal hyperplasia (CHA) can be a very useful biomarker to predict the course of these diseases [90,91]. High levels of Hcy seem to determine adverse cardiac remodeling, both directly affecting myocardium or as a result of an independent vascular effect [98].…”

Section: Hhcy and Cardiovascular Diseasesmentioning

confidence: 99%

“…A case-control study conducted on 36 children with congenital adrenal hyperplasia (CAH), and 36 controls [90] evaluated serum levels of Hcy in relation to relation to carotid artery intima-media thickness (CA-IMT) and left ventricular (LV) function. Compared to the controls, high serum Hcy levels and positive correlation with CA-IMT and left ventricular (LV) function were present in CAH-affected children.…”

Section: Hhcy and Cardiovascular Diseasesmentioning

confidence: 99%

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Homocysteine: Its Possible Emerging Role in At-Risk Population Groups

Azzini

Ruggeri

Polito

2020

IJMS

109

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Increased plasma homocysteine is a risk factor for several pathological disorders. The present review focused on the role of homocysteine (Hcy) in different population groups, especially in risk conditions (pregnancy, infancy, old age), and on its relevance as a marker or etiological factor of the diseases in these age groups, focusing on the nutritional treatment of elevated Hcy levels. In pregnancy, Hcy levels were investigated in relation to the increased risk of adverse pregnancy outcomes such as small size for gestational age at birth, preeclampsia, recurrent abortions, low birth weight, or intrauterine growth restriction. In pediatric populations, Hcy levels are important not only for cardiovascular disease, obesity, and renal disease, but the most interesting evidence concerns study of elevated levels of Hcy in autism spectrum disorder (ASD) and attention deficit hyperactivity disorder (ADHD). Finally, a focus on the principal pathologies of the elderly (cardiovascular and neurodegenerative disease, osteoporosis and physical function) is presented. The metabolism of Hcy is influenced by B vitamins, and Hcy-lowering vitamin treatments have been proposed. However, clinical trials have not reached a consensus about the effectiveness of vitamin supplementation on the reduction of Hcy levels and improvement of pathological condition, especially in elderly patients with overt pathologies, suggesting that other dietary and non-dietary factors are involved in high Hcy levels. The importance of novel experimental designs focusing on intra-individual variability as a complement to the typical case–control experimental designs and the study of interactions between different factors it should be emphasized.

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Homocysteine Level in Children with Classic Congenital Adrenal Hyperplasia: Relationship to Carotid Intimal Wall Thickness and Left Ventricular Function

Cited by 14 publications

References 31 publications

Effect of long‐term glucocorticoid therapy on cardiac functions in children with congenital adrenal hyperplasia

Effect of long‐term glucocorticoid therapy on cardiac functions in children with congenital adrenal hyperplasia

Cardiovascular Health in Children and Adolescents With Congenital Adrenal Hyperplasia Due to 21-Hydroxilase Deficiency

Homocysteine: Its Possible Emerging Role in At-Risk Population Groups

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