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Congenital Adrenal Hyperplasia in Children: The Relationship between Plasma Renin Activity and Hypertension
Siska Mayasari Lubis1, Frida Soesanti2, Eka Laksmi Hidayati2
1Department of Child Health, Faculty of Medicine, Universitas Sumatera Utara, Medan, Indonesia.
Insights
Children with salt-wasting Congenital Adrenal Hyperplasia (CAH) and low plasma renin activity (PRA) face a higher risk of hypertension. Monitoring PRA is crucial for managing hypertension in these pediatric patients.
Area of Science:
- Pediatric Endocrinology
- Clinical Research
- Hypertension Management
Background:
- Congenital Adrenal Hyperplasia (CAH) increases hypertension risk in children.
- Fludrocortisone medication and over-suppression are linked to higher hypertension rates.
- Plasma renin activity (PRA) indicates insufficient fludrocortisone dosage.
Purpose of the Study:
- To assess the relationship between plasma renin activity (PRA) and hypertension in 21-hydroxylase-deficient (21-OHD) CAH children.
- Investigate PRA as a potential indicator for hypertension risk in pediatric CAH.
- Evaluate hypertension prevalence in relation to PRA levels in 21-OHD CAH.
Main Methods:
- Cross-sectional observational study of 40 pediatric patients with 21-OHD CAH.
- Patients aged >6 months to 18 years, on hydrocortisone with/without fludrocortisone for ≥6 months.
- Data analyzed using unpaired t-test and multiple logistic regression; statistical significance at P<0.05.
Main Results:
- 50% of patients (20/40) had hypertension; higher incidence in salt-wasting CAH (59.3%) vs. simple virilizing (30.8%).
- Significant mean PRA difference between hypertensive and non-hypertensive salt-wasting CAH patients (P=0.016).
- Low PRA levels correlated with a 1.09 times higher risk of hypertension in salt-wasting CAH.
Conclusions:
- Children with salt-wasting CAH and low PRA levels exhibit an increased risk of hypertension.
- PRA monitoring is vital for identifying hypertensive risk in pediatric CAH.
- Early detection and management of hypertension in CAH can be informed by PRA levels.
Background:
Children with Congenital Adrenal Hyperplasia (CAH) have a higher chance of hypertension. The likelihood of hypertension is higher in CAH children who get fludrocortisone medication and have an over-suppression. Plasma renin activity (PRA) is a sensitive indicator when the fludrocortisone dose is insufficient. The objective of this study is to assess the relationship between plasma renin activity with hypertension in 21-hydroxylase-deficient (21-OHD) CAH children.
Methods:
This cross-sectional observational analytical study was conducted in 2019 at the Pediatric Endocrinology Outpatient Clinic in Dr. Cipto Mangunkusumo Hospital (RSCM), Jakarta, Indonesia. The subjects were 21-OHD CAH children, aged >6 months to 18 years who had already taken hydrocortisone with or without fludrocortisone for at least 6 months, and were divided into hypertension and non-hypertension groups. The subjects were selected by a consecutive sampling method. Data was analyzed using SPSS software (version 23.0) with unpaired t test analysis and multiple logistic regression test. Statistical significance was achieved if P<0.05.
Results:
Forty 21-OHD CAH patients were included, and 20 subjects (50%) had hypertension. A higher incidence of hypertension was found in salt-wasting CAH than in simple virilizing types (59.3% vs 30.8%). There was a significant mean difference in PRA levels between hypertension and non-hypertension groups in salt-wasting patients (P=0.016). A significant difference between the last dose of hydrocortisone with the number of hypertension patients in salt-wasting patients (P=0.032) was found, and low PRA levels showed a 1.09 times higher risk of hypertension.
Conclusion:
Children with salt-wasting CAH with low PRA levels had a higher risk of getting hypertension.
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