SFEBES2009 Poster Presentations Steroids (36 abstracts)
The role of serum and urinary steroids in the monitoring of adults with congenital adrenal hyperplasia
N Reisch 1,2 , N Krone 1 , B A Hughes 1 , D A Vassiliadi 1 , L Flade 2 , M Bidlingmaier 2 , C H L Shackleton 1 , P M Stewart 1 & W Arlt 1
1School of Clinical & Experimental Medicine, University of Birmingham, Birmingham, UK; 2Department of Medicine Innenstadt, University Hospital Munich, Munich, Germany.
Glucocorticoid treatment in congenital adrenal hyperplasia (CAH) is a continuous challenge, with even the experienced clinician struggling to strike the right balance between glucocorticoid over- and undertreatment. There is no consensus on monitoring of glucocorticoid therapy in adults with CAH. Some recommend a serum 17-hydroxyprogesterone (17OHP) target range of 12–36 nmol/l prior to glucocorticoid morning dose. Here we investigated the value of serum and urinary steroids as a monitoring tool in adults with CAH (n=59; 30 females, median (±S.D.) age 32.4±8.2 years). Obesity was present in 39%; only 27% were normal weight. Patients received treatment with hydrocortisone (HC, n=14; BMI 26.5±3.5 kg/m2), prednisolone (n=29; 28.1±5.0 kg/m2) and dexamethasone (Dex, n=16; 31.3±6.1 kg/m2) (BMI HC versus Dex, P<0.05). Blood for serum 17OHP, androstenedione, and testosterone was collected at 9–11 a.m after intake of morning glucocorticoids; a 24-h urine was collected for measurement of 17OHP metabolites (U-17OHPmet) and androgen metabolites (U-An; androsterone+etiochalanolone) by gas chromatography/mass spectrometry. Serum androstenedione, testosterone and U-An were within the sex-specific normal range in 58, 66 and 59%, respectively. Serum 17OHP and U-17OHPmet were increased above the normal range in 63 and 78%, respectively. In both sexes, 17OHP correlated significantly with androstenedione (P<0.001) and U-An (P<0.001). In patients with S-17OHP 12–36 nmol/l androstenedione, testosterone and U-An were within the normal range in 90, 90 and 70%, respectively; decreased levels were found in 0, 10 and 20%. Patients with S-17OHP <12 nmol/l had suppressed androstenedione, testosterone and U-An in 35, 33 and 46% whereas patients with S-17OHP >36 had increased androstenedione, testosterone and U-An in 87, 27 and 27%, respectively. In conclusion, S-17OHP 12–36 nmol/l appears to be a surprisingly useful target range after intake of the morning glucocorticoid dose; applying the same range to patients sampled prior to morning glucocorticoid dose is likely to result in significant overtreatment.
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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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