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Assessment of cardiac function in children with congenital adrenal hyperplasia: a case control study in Cameroon
J Tony Nengom1, S Sap Ngo Um2,3, D Chelo2,3
1Faculty of Medicine and Biomedical Sciences of Yaounde I University, P.O Box: 14855, Yaounde, Cameroon. tnengom@gmail.com.
Insights
Children with congenital adrenal hyperplasia (CAH) show altered heart function, particularly impaired diastolic function, compared to healthy peers. Early diagnosis and monitoring are crucial for managing cardiac health in CAH patients.
Area of Science:
- Pediatric Endocrinology
- Cardiology
- Genetics
Background:
- Congenital adrenal hyperplasia (CAH) is associated with elevated androgen levels.
- High androgen levels may negatively impact cardiac function in children.
Purpose of the Study:
- To evaluate and compare the cardiac function of children diagnosed with CAH against a healthy control group.
- To identify potential correlations between cardiac abnormalities and disease characteristics in CAH.
Main Methods:
- A case-control study involving 19 children with CAH and 38 healthy controls.
- Echocardiographic parameters including left ventricular ejection fraction (LVEF), fractional shortening, left ventricular mass, and diastolic function (E/A waves, deceleration time) were assessed.
- Right ventricular function and pulmonary artery systolic pressure were also measured.
Main Results:
- Children with CAH exhibited greater left ventricular mass compared to controls.
- While systolic function parameters (LVEF, fractional shortening) were numerically higher in CAH patients, the difference was not statistically significant.
- Diastolic left ventricular function was significantly more impaired in children with CAH.
- A case of reversible cardiomyopathy was observed during hormone replacement therapy.
- Cardiac abnormalities correlated with later age at diagnosis and longer treatment duration.
Conclusions:
- Children with CAH demonstrate altered cardiac function, with impaired diastolic function being a key finding.
- Early diagnosis, stringent androgen level control, and regular cardiac monitoring are essential for managing CAH patients.
- Findings underscore the importance of a multidisciplinary approach to CAH care, integrating endocrinology and cardiology.
Background:
High level of androgens found in congenital adrenal hyperplasia (CAH) seems to have a deleterious effect on heart function. We therefore evaluate cardiac function of children with CAH in comparison with a healthy group.
Methods:
We carried out a case-control study in the single endocrinology unit of the Mother and Child Center of Chantal Biya's Foundation. Cases were matched for age and genotypic sex to 2 healthy controls. We analyzed the ejection fraction (LVEF), fractional shortening and left ventricular mass; output and cardiac index; E and A waves velocities, E/A ratio and the mitral deceleration time and diameter of the left atrium; tricuspid annular plane systolic excursion and pulmonary artery systolic pressure were also measured.
Results:
We included 19 patients with a median age of 6.26 ± 3.75 years and 38 controls stackable distribution. The left ventricular mass of cases was greater than that of controls. A case of reversible cardiomyopathy on hormone replacement therapy was found. For the cases, the average ejection fraction was 71.95 ± 7.88%; the average fractional shortening was 40.67 ± 7.02%. All these values were higher than those of controls, although the difference was not statistically significant. Diastolic left ventricular function was more impaired among the cases. Right ventricular function was similar in both groups. These abnormalities were highly correlated to the late age at diagnosis and duration of treatment.
Conclusion:
This study shows an altered cardiac function in CAH compared to healthy control and highlights importance of an early diagnosis of cases, a tight control of androgens levels and a regular monitoring of cardiac function.
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