ISSN 1470-3947 (print) | ISSN 1479-6848 (online)

Endocrine Abstracts (2019) 66 OC4.9 | DOI: 10.1530/endoabs.66.OC4.9

Health status of children aged 8-18 years with 21-hydroxylase deficiency in the United Kingdom: results of a multi-centre cohort study

Irina-Alexandra Bacila1, Sundus Mahdi1, Carlo L Acerini2, Ruth Krone3, Leena Patel4, Sabah Alvi5, Tabitha Randell6, Evelien Gevers7, Mehul Dattani8, Timothy Cheetham9, Andreas Kyriakou10, Fiona Ryan11, Elizabeth Crowne12, Justin H Davies13, Urmi Das14, S Faisal Ahmed10 & Nils Krone1

1Academic Unit of Child Health, Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK; 2Department of Paediatrics, University of Cambridge, Cambridge, UK; 3Birmingham Women’s & Children’s Hospital, Birmingham, UK; 4Paediatric Endocrine Service, Royal Manchester Children’s Hospital, Manchester University NHS Foundation Trust, Manchester, UK; 5Leeds General Infirmary, Leeds, UK; 6Nottingham Children’s Hospital, Nottingham, UK; 7Centre for Endocrinology, William Harvey Research Institute, Queen Mary University London, London and Barts Health NHS Trust – The Royal London Hospital, London, UK; 8Great Ormond Street Hospital, London, UK; 9Great North Children’s Hospital, University of Newcastle, Newcastle, UK; 10Developmental Endocrinology Research Group, University of Glasgow, Glasgow, UK; 11Oxford Children’s Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK; 12Bristol Royal Hospital for Children, University Hospitals Bristol Foundation Trust, Bristol, UK; 13University Hospital Southampton, Southampton, UK; 14Alder Hey Children’s Hospital, Liverpool, UK

Introduction: There is limited knowledge on the impact of congenital adrenal hyperplasia (CAH) on the health and well-being of children and young persons (CYP). We aimed to establish the health status of CYP with CAH across the United Kingdom.

Methods: We conducted a national multi-centre prospective study recruiting 107 patients aged 8–18 with 21-hydroxylase deficiency from 14 centres and 83 matched controls. Demographic, clinical, metabolic data, as well as Strengths and Difficulties (SDQ) and Paediatric Quality of Life (PedsQL) questionnaires were collected and analysed.

Results: Most CAH patients were of White (73.8%) or Southeast Asian (18.6%) ethnicity. Glucocorticoid treatment consisted primarily of hydrocortisone (94.3%), with 76.6% patients also receiving fludrocortisone. 34.3% patients required admission for adrenal crisis after diagnosis. Delta-SDS for target height was 1.2±1.4 for patients younger than 12 years and 0.3±1.6 for 12- to 18-year-olds; patients under 12 years were taller (P=0.02) and patients aged 12–18 years shorter (P=0.03) than controls. Patient weight-SDS (0.87; 0.03–1.35) and body-mass-index-SDS (0.98; −0.04 to 1.94) were significantly higher compared to controls; 27.7% of patients were overweight and 22.8% obese. Five patients had high blood pressure. Post-glucocorticoid dose androstenedione was normal in 32%, suppressed in 7%, and elevated in 50% of patients; 17-hydroxyprogesterone was within target range in 20%, suppressed in 19%, and increased in 43% of patients. Biochemistry indicated normal sodium in all patients, low potassium in 1 patient, normal glucose in all, mildly raised creatinine in 9.8%, high lipids in 9.8% patients. Associated behavioural and mental health problems were reported for 11.3% patients aged 12–18 years, similar to the general population. SDQ questionnaires showed ‘high’ or ‘very high’ scores for 15.1% patients, most commonly related to hyperactivity and peer problems. The median with interquartile range for PedsQL scores was 81(72–88), the areas marked lowest being emotional and school functioning.

Conclusion: Our findings suggest that children with CAH have increased prevalence of growth problems and metabolic co-morbidities, as well as reduced quality of life and mental health well-being. The development of improved standardised strategies for the management and monitoring of CAH in childhood is required in order to improve long-term patient outcomes.

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