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

Abstract

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.

Growth characteristics in children with congenital adrenal hyperplasia

“…It is essential to carefully adjust HC dosing in CAH children, especially during early childhood, to prevent increased weight gain and an early adiposity rebound. 18 The adiposity rebound is defined as the second increase in BMI that happens in preschoolers until the age of 7. An early age at adiposity rebound is a risk factor for adult obesity.…”

The High Prevalence of Testicular Adrenal Rest Tumors in Adult Men With Congenital Adrenal Hyperplasia Is Correlated With ACTH Levels

“…Treatment with excessively high dose of glucocorticoids must be avoided as it may lead to the development of diabetes and obesity, insulin resistance, and osteoporosis (1, 2, 20, 21). Glucocorticoid-induced hyperglycemia depends on the total glucocorticoid dose and duration of therapy and may occur also in <1 month (22).…”

Review of Health Problems in Adult Patients with Classic Congenital Adrenal Hyperplasia due to 21-Hydroxylase Deficiency

“…The major cardiovascular risk factor in CAH seems to be overweight and obesity [20]. Obesity was identified already a major problem in pediatric cohorts [25,26]. In adult cohorts even more than half of the female patients were found to be obese [20].…”