Increased Abdominal Adiposity in Adolescents and Young Adults With Classical Congenital Adrenal Hyperplasia due to 21-Hydroxylase Deficiency

Kim, Mimi; Ryabets-Lienhard, Anna; Dao-Tran, Anh; Mittelman, Steven D.; Gilsanz, Vicente; Schrager, Sheree M.; Geffner, Mitchell E.

doi:10.1210/jc.2014-4033

Cited by 53 publications

(50 citation statements)

References 34 publications

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“…Chronically, intermittently elevated adrenal androgen levels due to shortcomings of current therapy in both males and females may be one of the reasons that there was no difference in obesity status between sexes within subtypes. A recent study reported higher visceral and subcutaneous fat measured by computed tomography imaging in 28 adolescents and adults with CAH compared to healthy controls; the study found no difference in visceral or subcutaneous fat between sexes and found no correlation with glucocorticoid dosing …”

Section: Discussionmentioning

confidence: 90%

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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: Discussionmentioning

confidence: 90%

“…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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“…Our study was the first to use DXA to calculate VAT in children with CAH and found no difference in VAT between cases and controls. Only one previous study, by Kim et al, quantitated VAT in children with CAH using a computed tomography scan and found increased VAT in 28 children with CAH. Several factors other than the measurement method may account for this difference.…”

Section: Discussionmentioning

confidence: 99%

“…et al,32 quantitated VAT in children with CAH using a computed tomography scan and found increased VAT in 28 children with CAH. Several factors other than the measurement method may account for this difference.…”

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confidence: 99%

Bone mineral density and body composition in children with congenital adrenal hyperplasia

Halper

Sánchez

Hodges

et al. 2018

Clinical Endocrinology

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“…Our findings in CAH, compared to a BMI-matched cohort, suggest that individuals with classical CAH due to 21-hydroxylase deficiency may not develop subclinical atherosclerosis in adolescence. Nevertheless, since it is known that CAH confers a higher relative risk for obesity and adiposity in childhood and adolescence [5,6,34], it remains concerning that obese CAH subjects exhibit higher CIMT than their non-obese counterparts.…”

Section: Discussionmentioning

confidence: 99%

Carotid Intima-Media Thickness Is Associated with Increased Androgens in Adolescents and Young Adults with Classical Congenital Adrenal Hyperplasia

Kim

Dao-Tran²,

Davidowitz³

et al. 2016

Horm Res Paediatr

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Background/Aims: Youth with congenital adrenal hyperplasia (CAH) due to 21-hydroxylase deficiency develop cardiovascular disease (CVD) risk factors of obesity and hypertension. Carotid intima-media thickness (CIMT), a marker of CVD risk, is increased in CAH young adults. We examined CIMT and its relationship with androgens and obesity in adolescents/young adults with CAH. Methods: Twenty CAH subjects (age 16 ± 3.3 years, 50% female) and 20 matched controls were studied cross-sectionally. Eight additional obese patients with CAH were included in within-group comparisons. CIMT by high-resolution ultrasound, androgens, anthropometry, bone age (BA), and metabolic/inflammatory markers were assessed. Results: Within the CAH group, CIMT correlated with 17-hydroxyprogesterone (r = 0.48, p < 0.05) and androstenedione (r = 0.46, p < 0.05), and was greater in obese subjects. CIMT was greater in CAH males than females, but similar among CAH females with advanced BA, CAH males with normal BA, and control males. There was no difference in CIMT between CAH and controls, although high-density lipoprotein was inversely correlated with CIMT in both groups. Conclusion: CIMT is associated with increased androgens in CAH adolescents and young adults, with loss of sex differences in CAH females with excess androgen exposure. Our findings highlight the importance of hormonal control for CVD prevention in CAH.

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Increased Abdominal Adiposity in Adolescents and Young Adults With Classical Congenital Adrenal Hyperplasia due to 21-Hydroxylase Deficiency

Abstract: CAH adolescents and young adults have increased abdominal adiposity, with a higher proportion of proinflammatory VAT than SAT. An improved understanding of the mechanism of obesity in CAH may lead to targeted prevention and therapeutics in this high-risk population.

Cited by 53 publications

References 34 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

Bone mineral density and body composition in children with congenital adrenal hyperplasia

Carotid Intima-Media Thickness Is Associated with Increased Androgens in Adolescents and Young Adults with Classical Congenital Adrenal Hyperplasia

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