BSPED2022 Poster Presentations Adrenal 1 (6 abstracts)
Mean glucose concentrations are increased, and cardiovascular risk factors are common in children and young people with secondary adrenal insufficiency (GRACE2)
Julie Park 1,2 , Lily Jones 2 , Silothabo Dliso 1 , Daniel Hawcutt 1,2 , Alena Shantsila 2,3 , Gregory Lip 2,3 & Joanne Blair 1
1Alder Hey Children’s NHS Foundation Trust, Liverpool, United Kingdom; 2University of Liverpool, Liverpool, United Kingdom; 3Liverpool Centre for Cardiovascular Science, Liverpool, United Kingdom
Background: Hypoglycaemia, possibly due to non-physiological hormone replacement, and poor cardiovascular outcomes are described in patients with adrenal insufficiency (AI), particularly in the adult population. In this study, we describe glucose profiles and risk factors for premature cardiovascular disease (CVD) in children with secondary AI (SAI).
Methods: Participants underwent continuous glucose monitoring (CGM), for seven days (blinded Dexcom G6 monitor). The following risk factors for CVD were measured: clinic blood pressure (BP) and 24-hour ambulatory BP monitoring (ABPM), carotid intima media thickness (CIMT), brachial artery flow mediated dilatation (FMD), body mass index standard deviation score (BMI SDS), HOMA-IR [(fasting insulin (microU/l) x fasting glucose (nmol/l)/22.5)], and von Willebrand factor (vWF) antigen and activity.
Results: 20 (9M) patients, median age 13.0 years (IQR 9.8-15.3), 6 congenital and 14 acquired SAI participated. All had ≥1 other hypothalamic-pituitary axis affected. Hydrocortisone dose was 8.6 ± 1.4 mg/m2/day, height SDS -0.2 ±1.25, BMI SDS 1.8 ±1.5. Mean glucose levels were higher in SAI than in data reported in healthy children 5.91 (± 0.43) mmol/l vs 5.55 (± 0.36) mmol/l, P<0.001[1]. Risk factors for CVD are shown below.
| Mean (±SD) | Number (%) >95th centile | |
| Cardiovascular outcome | ||
| Clinic BP | ||
| • Systolic percentile | 67.9 ± 20.2 | 1 (5.0%) |
| • Diastolic percentile | 60.8 ± 29.8 | 2 (10.0%) |
| ABPM | ||
| • Systolic percentile | 0 (0.0%) | |
| • Diastolic percentile | 1 (5.0%) | |
| Loss of nocturnal dip* | 8 (57.0%) | |
| CIMT (mm) | 0.43 ± 0.03 | 4 (22.2%) |
| FMD (%) | 10.6 ± 6.3 | 3 (20.0%) ** |
| Metabolic outcome | ||
| BMI SDS | 1.8 ± 1.49 | 11 (55.0%) |
| HOMA-IR (mass units) | 5.0 ± 6.15 | 7 (38.9%) |
| VWF antigen and activity (%) | - | 4 (28.6%) |
| *less than 10% difference in day and night readings **Measurements <7%, reference range 7-15% | ||
Conclusion: To our knowledge, this is the first report of elevated glucose concentrations in patients with SAI, the clinical significance of which is unknown. It is possible that minor, but lifelong increases in blood glucose have an adverse effect on health. We identified multiple risk factors for CVD, and early intervention to address modifiable risk factors may improve long term cardiovascular health.
References: 1. Shah, V.N., et al (2019) JCEM
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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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