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Hypertension in children with congenital adrenal hyperplasia

Nadia Maccabee-Ryaboy1, William Thomas2, Jennifer Kyllo3

  • 1University of Minnesota Masonic Children's Hospital, Minneapolis, MN, USA.

Clinical Endocrinology
|April 23, 2016
PubMed

Insights

Children with congenital adrenal hyperplasia (CAH) have increased hypertension risk, particularly those on fludrocortisone and with oversuppressed 17-OHP levels. Incidence varies by CAH subtype and sex, with salt-wasting forms showing higher rates.

Area of Science:

  • Pediatric Endocrinology
  • Cardiovascular Health in Genetic Disorders

Background:

  • Congenital adrenal hyperplasia (CAH) presents diverse clinical phenotypes, with varying estimates of hypertension incidence.
  • Risk factors for hypertension in pediatric CAH patients remain incompletely understood.

Purpose of the Study:

  • To estimate hypertension incidence stratified by CAH subtype and sex.
  • To investigate associations between hypertension and body mass index, hydrocortisone, and fludrocortisone use.

Main Methods:

  • Longitudinal chart review of 180 pediatric CAH patients (1970-2013).
  • Hypertension defined as blood pressure ≥95th percentile on at least three occasions.
  • Analysis included CAH subtype (salt-wasting vs. simple virilizing) and medication use.

Main Results:

  • Hypertension incidence was higher in salt-wasting CAH (58%) than simple-virilizing CAH (35%).
  • Children on fludrocortisone had significantly higher hypertension rates (55% vs. 31%).
  • Oversuppression (17-OHP < 400 ng/dl) was associated with increased hypertension, especially in salt-wasting males on fludrocortisone.

Conclusions:

  • Pediatric CAH patients face elevated hypertension risk compared to the general population.
  • Fludrocortisone use and oversuppression are linked to higher hypertension incidence in CAH.
  • Hypertension risk and timing differ significantly by CAH subtype and sex.
Abstract

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