Longitudinal assessment of cardiometabolic risk factors in adults with classic congenital adrenal hyperplasia: influence of hormonal control

Maues de Oliveira Ana Carolina; Lin Ie Jessica Me; de Souza Trigueiro Nicholas Silvestre; de Miranda Mirela Costa; Guiomar Madureira; Ana Claudia Latronico; Berenice B. Mendonca; Marisa Passareli; Tania A S S Bachega

doi:10.1530/endoabs.118.PO71

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Endocrine Abstracts (2026) 118 PO71 | DOI: 10.1530/endoabs.118.PO71

IDSD2026 Poster Abstracts Poster Abstracts (93 abstracts)

Longitudinal assessment of cardiometabolic risk factors in adults with classic congenital adrenal hyperplasia: influence of hormonal control

Ana Carolina Maués de Oliveira ¹ , Jessica Me Lin Ie ¹ , Nicholas Silvestre de Souza Trigueiro ¹ , Mirela Costa de Miranda ¹ , Guiomar Madureira ¹ , Ana Claudia Latrônico ¹ , Berenice B. Mendonça ¹ , Marisa Passareli ² & Tania A S S Bachega ¹

Author affiliations

¹Laboratório de Hormônios e Genética Molecular - LIM/42, Unidade de Desenvolvimento, Disciplina de Endocrinologia e Metabologia, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brasil; ²Laboratório de Lípides - LIM/10, Disciplina de Endocrinologia e Metabologia, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brasil. Correspondence to: [email protected]

Background: Adults with classic congenital adrenal hyperplasia (CAH) may be predisposed to cardiometabolic complications due to lifelong glucocorticoid (GC) exposure and/or periods of androgen excess. However, longitudinal data extending into adulthood, particularly those regarding of the influence of hormonal control on metabolic outcomes, remain limited. This study aimed to evaluate long-term changes in metabolic risk factors in adults with classic CAH from the transition period to adulthood according to hormonal control status.

Methods: This longitudinal observational study was conducted at a single tertiary referral center. Fifty-nine adults with classic CAH were followed from late adolescence (mean age 18.6 ± 1.5 years) for an average of 14.8 ± 9.2 years; the evaluation of these patients generated a total of 2783 data points for analysis. Hormonal control was classified using serum androstenedione and 17-hydroxyprogesterone levels. Long-term changes and mixed-effects predictors of BMI, fasting blood glucose, HOMA-IR, and serum lipid profile (LDL-c, HDL-c, and triglycerides) were evaluated.

Results: Participants received relatively low GC doses, which declined from 11.2 ± 8.1 to approximately 6–7 mg/m²/day (in hydrocortisone equivalents) during follow-up. BMI was already increased at baseline (25.4 ± 5.0 kg/m²) and remained stable throughout follow-up. Mean fasting blood glucose and lipid parameters remained within normal ranges. BMI and age were strong predictors of higher LDL-c and triglycerides, while higher BMI and androstenedione levels were associated with lower HDL-c. BMI was the main determinant of insulin resistance, and HOMA-IR decreased from 3.52 ± 2.95 at the transition period to lower values in later assessments. Higher BMI was also associated with lower mean GC doses, consistent with clinical dose-adjustment practices.

Conclusions: In adults with classic CAH treated with relatively low GC doses, cardiometabolic parameters remained stable across follow-up. Notably, many individuals already entered adulthood with overweight or obesity. Adiposity and age, rather than GC exposure or hormonal control, were the main determinants of metabolic variability, highlighting the importance of early weight-management strategies in this population.