Background: Quality of life (QoL) has been variously reported as normal or impaired in congenital adrenal hyperplasia (CAH) adults. We found impaired QoL in UK CAH adults (Arlt et al. Journal of Clinical Endocrinology and Metabolism 2010 95 51105121) and now report the relationship between QoL (SF-36) and health outcomes in these patients.
Methods: Cross-sectional analysis of 151 CAH adults with 21-hydroxylase deficiency aged 1869 years. QoL was transformed into age- (decade) and sex-adjusted z-scores using reference data from random sample of 14 430 UK subjects aged 1879 years (Prof. John Brazier, Sheffield University). Principal components analysis (PCA) was undertaken to identify clusters of inter-related clinical and biochemical features (waist circumference, systolic and diastolic blood pressure, serum triglycerides, HDL-cholesterol, HOMA-IR testosterone, androstenedione, 17-hydroxyprogesterone and mutation severity). The principal component (PC) scores were used in multiple stepwise regression analysis as predictor variables of QoL.
Results: Three PCs were identified by PCA that explain 61% of the total variance (r2) in observed variables. Regression analysis demonstrated that PC2, reflecting adiposity and insulin resistance (waist circumference, serum triglycerides, HOMA-IR and HDL-cholesterol), related to individual QoL scores, specifically impaired physical function (β=−0.72, 95% CI: −1.11 to −0.34, r2=19.9%, P<0.001), bodily pain (β=−0.51, 95% CI: −0.77 to −0.23, r2=21.6%, P<0.001), general health (β=−0.50, 95% CI: −0.80 to −0.20, r2=16.0%, P=0.001), vitality (β=−0.44, 95% CI: −0.65 to −0.16 r2=15.5%, P=0.002), and the Physical Components Summary Score (β=−0.58, 95% CI: −0.83 to −0.33, r2=26.4%, P<0.001), but not to the Mental Components Summary Score.
Conclusions: Increased adiposity and insulin resistance are associated with impaired QoL in adults with CAH. Intervention studies are now required to establish whether reduction in metabolic risk factors can improve QoL in this disadvantaged patient group.
27 Apr - 01 May 2013
European Society of Endocrinology