SFEBES2014 Poster Presentations Growth and development (9 abstracts)
Relationships between final height and health outcomes in adults with congenital adrenal hyperplasia: United Kingdom Congenital adrenal Hyperplasia Adult Study Executive (CaHASE)
Thang Han 1 , Roland Stimson 2 , Aled Rees 3 , Nils Krone 4 , Debbie Willis 5 , Gerard Conway 1 , Wiebke Arlt 4 , Brian Walker 2 & Richard Ross 6
1Department of Endocrinology, University College London, London, UK; 2Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK; 3Institute for Molecular and Experimental Medicine, Cardiff, UK; 4Centre for Endocrinology, Diabetes and Metabolism, Birmingham, UK; 5Society for Endocrinology, Bristol, UK; 6Academic Unit of Diabetes, Endocrinology and Metabolism, Sheffield, UK.
Background: Treatment of congenital adrenal hyperplasia (CAH) in childhood focuses on growth and development; however the relationship of childhood treatment with adult health outcomes is not established. We explored this by examining relationships between final height (FH) and cardiometabolic risk in CAH adults.
Methods: Cross-sectional analysis of 65 men (80% salt wasting (SW) and 20% non-SW) and 134 women (74% SW and 26% non-SW), aged 18–69 years. FH was expressed as z-scores adjusted for mid-parental target height (FHTH) or UK population height (FHUK).
Results: FH correlated inversely with age (men β=−0.30, r=−0.38, P<0.01 and women β=−0.18, r=−0.26, P<0.01); older men and women were 3 and 2 cm, respectively, shorter per decade. FH z-scores were −2 (men) and −1 (women) below TH and both sexes had FH z-scores −1 below the reference population (P<0.01). In women, FH was shorter in non-SW than SW classic CAH (P<0.05) and in moderately affected genotype group B women than either more severely affected groups Null and A (P<0.01) or mildest group C (P<0.001). Classic CAH men and women diagnosed after 1-year-old were also shorter (P<0.05). In women, the shortest group (lowest FHTH tertile) was 3.6 times (95% CI 1.2–10.8, P<0.05) more likely to have hypertension than the tallest group (highest FHTH tertile). Similar observations were made using FHUK tertiles. FH did not associate with insulin sensitivity, lipid profile, or waist circumference.
Conclusions: Adult CAH patients remain shorter than predicted although height prognosis has improved over time suggesting better management in childhood. Patients diagnosed late with moderate severity CAH (e.g. after 1-year-old with pseudo-precocious puberty) are shorter as adults, and in women short stature was associated with adult hypertension. We suggest this group are likely to be exposed to high androgens and/or to excessive glucocorticoid treatment in childhood, with consequent reduced FH and potential programming of hypertension.
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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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