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Cardiovascular dysfunction risk in young adults with congenital adrenal hyperplasia caused by 21-hydroxylase enzyme
Juliano Henrique Borges1, Renata Isa Santoro2, Daniel Minutti de Oliveira3
1Laboratory of Growth and Development (LabCreD), Center for Investigation in Pediatrics (CIPED), School of Medical Sciences (FCM), State University of Campinas (UNICAMP), Campinas, Brazil.
Background:
The association of congenital adrenal hyperplasia (CAH) caused by 21-hydroxylase enzyme (21OHase) deficiency, duration of treatment and dosage with cardiovascular dysfunction in young adults remains unclear. We aimed to evaluate myocardial function, vascular structures and epicardial fat thickness in young adults with CAH as a result of 21OHase deficiency. Correlations between the duration and dose of glucocorticoid therapy and cardiovascular parameters were analysed.
Methods:
This case-control study of young adults (18-31 years old) included 20 patients (5 men and 15 women) and 16 control subjects (8 men and 8 women). Echocardiographic analysis was performed using high-resolution ultrasound.
Results:
No ultrasonographic changes in any indices of myocardial function, vascular structures and epicardial fat thickness were found in patients, except for an impaired left ventricular end-diastolic diameter in female patients (28.1 ± 1.6 vs 26.0 ± 2.4 mm/m2 , P = .021), compared with those in individuals in the control group. Nevertheless, the individual patient values were within the normal range. Multiple linear regression analysis in female patients demonstrated that an elevated daily dose of glucocorticoids correlated with increased indices of left ventricular posterior wall thickness (Partial r = 0.68, P = .007), left ventricular end-diastolic diameter (Partial r = 0.62, P = .017), aortic diameter (Partial r = 0.60, P = .022) and left carotid artery intima-media thickness (Partial r = 0.61, P = .021), independently of treatment duration.
Conclusion:
No signs of cardiovascular dysfunction were observed in any patient. The daily dose of glucocorticoids may play a role in the mechanisms of some markers of cardiac hypertrophy, left ventricular and aortic dilation and subclinical atherosclerosis.
Insights
Congenital adrenal hyperplasia (CAH) patients showed no cardiovascular dysfunction. However, higher glucocorticoid doses in females correlated with cardiac and vascular changes, suggesting a potential role in hypertrophy and atherosclerosis.
Area of Science:
- Endocrinology
- Cardiology
- Genetics
Background:
- Congenital adrenal hyperplasia (CAH) due to 21-hydroxylase (21OHase) deficiency is a genetic disorder.
- The impact of CAH treatment on cardiovascular health in young adults is not well understood.
- This study investigates cardiac and vascular parameters in young adults with CAH.
Purpose of the Study:
- To evaluate myocardial function, vascular structures, and epicardial fat thickness in young adults with CAH.
- To analyze the correlation between glucocorticoid therapy (duration and dose) and cardiovascular parameters.
- To identify potential cardiovascular risks associated with CAH and its treatment.
Main Methods:
- A case-control study involving 20 young adults with CAH (18-31 years) and 16 healthy controls.
- High-resolution ultrasound and echocardiography were used for cardiovascular assessments.
- Statistical analyses, including multiple linear regression, were performed to identify correlations.
Main Results:
- No significant differences in overall myocardial function, vascular structures, or epicardial fat were found between CAH patients and controls.
- Female CAH patients exhibited impaired left ventricular end-diastolic diameter compared to controls, though values remained within the normal range.
- In female patients, higher daily glucocorticoid doses correlated with increased left ventricular posterior wall thickness, left ventricular end-diastolic diameter, aortic diameter, and carotid intima-media thickness.
Conclusions:
- Young adults with CAH do not exhibit overt signs of cardiovascular dysfunction.
- Elevated glucocorticoid dosage, independent of treatment duration, may be linked to cardiac hypertrophy, left ventricular and aortic dilation, and subclinical atherosclerosis.
- Further research is warranted to elucidate the long-term cardiovascular implications of CAH treatment.
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