Endocrine Abstracts

Background: Adults with classical congenital adrenal hyperplasia (CAH) due to 21-hydroxylase deficiency may present alterations in body composition and increased cardiometabolic risk. The visceral-to-subcutaneous adipose tissue ratio (VAT/SAT) has emerged as a marker of adverse fat distribution and metabolic risk. However, data regarding visceral fat distribution and its metabolic and hormonal correlates in adults with CAH remain limited.

Methods: A cross-sectional study included 23 adults with classical CAH (mean age 38 ± 11.5 years; 18 females; 12 with the salt-wasting form) and 23 healthy volunteers matched for sex, age, and body mass index (BMI). Visceral (VAT) and subcutaneous (SAT) adipose tissue areas were measured by abdominal computed tomography. Anthropometric data included BMI and waist circumference. Metabolic parameters comprised fasting glucose, HbA1c, and lipid profile. Hormonal markers of disease control (17-hydroxyprogesterone and androstenedione) and hydrocortisone-equivalent glucocorticoid dose (mg/m²) were assessed in CAH patients. Twenty patients were considered well-controlled. Group comparisons were performed using the Mann–Whitney test and correlations using Spearman coefficients.

Results: Most patients (62%) received low doses of dexamethasone (mean hydrocortisone-equivalent dose was 5.8 ± 4.9 mg/m²/day). Twelve patients (52%) received fludrocortisone (mean dose 50 ± 28 mg/day). The VAT/SAT ratio tended to be higher in CAH patients compared with controls (0.55 ± 0.28 vs 0.41 ± 0.26), although without statistical significance (P =0.18). In patients with CAH, VAT/SAT showed a significant positive correlation with BMI (r =0.52, P =0.03), suggesting an association between visceral fat distribution and overall adiposity. A trend toward an inverse correlation between VAT/SAT and HDL cholesterol was observed (r =-0.41, P =0.09), indicating a potential relationship between visceral adiposity and an unfavorable lipid profile. No significant correlations were found between VAT/SAT and hormonal control markers, including 17OHP or androstenedione. Likewise, VAT/SAT was not associated with hydrocortisone-equivalent glucocorticoid dose.

Conclusion: Adults with classical CAH may present a tendency toward higher visceral fat distribution compared with healthy controls. However, visceral adiposity appears to be more closely related to overall adiposity rather than hormonal disease control or glucocorticoid exposure. Larger studies are needed to confirm these findings. Study Grant from FAPESP #2019/26780-9 and #2023/11168-1.