Document Detail

Glucocorticoid treatment regimen and health outcomes in adults with congenital adrenal hyperplasia.
MedLine Citation:
PMID:  22998134     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Adults with congenital adrenal hyperplasia (CAH) are treated with a wide variety of glucocorticoid treatment regimens.
OBJECTIVE, DESIGN AND METHODS: To test whether drug dose and timing of glucocorticoid treatment regimen impacts on health outcomes. This was a cross-sectional study of 196 adult CAH patients in whom treatment and health outcomes were measured. Glucocorticoid dose was converted to prednisolone dose equivalent (PreDEq) using three published formulae. Associations between the type of glucocorticoid regimen and PreDEq with specific health outcome variables were tested using partial correlation and principal components analysis (PCA).
RESULTS: Patients on dexamethasone had lower androgens and ACTH but greater insulin resistance compared with those receiving hydrocortisone or prednisolone. Dexamethasone dose and once daily administration were associated with insulin resistance. Partial correlation analysis adjusted for age and sex showed PreDEq weakly correlated (r < 0·2) with blood pressure and androstenedione. Mutation severity was associated with increased PreDEq (F(3,141)  = 4·4, P < 0·01). In PCA, 3 PCs were identified that explained 62% of the total variance (r(2) ) in observed variables. Regression analysis (age and sex adjusted) confirmed that PC2, reflecting disease control (androstenedione, 17-hydroxypregesterone and testosterone), and PC3, reflecting blood pressure and mutations (systolic and diastolic blood pressure and mutation severity), related directly to PreDEq (r(2)  = 23%, P < 0·001).
CONCLUSIONS: In adults with congenital adrenal hyperplasia, dexamethasone use was associated with lower androgens but greater insulin resistance, and increasing glucocorticoid dose associated with increased blood pressure, poor disease control and mutation severity.
T S Han; R H Stimson; D A Rees; N Krone; D S Willis; G S Conway; W Arlt; B R Walker; R J Ross;
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Clinical endocrinology     Volume:  78     ISSN:  1365-2265     ISO Abbreviation:  Clin. Endocrinol. (Oxf)     Publication Date:  2013 Feb 
Date Detail:
Created Date:  2013-01-08     Completed Date:  2013-06-06     Revised Date:  2014-02-20    
Medline Journal Info:
Nlm Unique ID:  0346653     Medline TA:  Clin Endocrinol (Oxf)     Country:  England    
Other Details:
Languages:  eng     Pagination:  197-203     Citation Subset:  IM    
Copyright Information:
© 2012 Blackwell Publishing Ltd.
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MeSH Terms
Adrenal Hyperplasia, Congenital / drug therapy*
Cross-Sectional Studies
Dexamethasone / administration & dosage,  therapeutic use*
Drug Therapy, Combination
Energy Metabolism / drug effects
Hydrocortisone / administration & dosage,  therapeutic use*
Middle Aged
Young Adult
Grant Support
G0900567//Medical Research Council; RG/11/4/28734//British Heart Foundation
Reg. No./Substance:
7S5I7G3JQL/Dexamethasone; WI4X0X7BPJ/Hydrocortisone
W Arlt / ; U Ayyagari / ; S Ball / ; J S Bevan / ; S A Booth / ; U Bradley / ; L Breen / ; P V Carroll / ; T Clements / ; T Chambers / ; T R Cole / ; J M C Connell / ; G Conway / ; M Daly / ; J R Davis / ; A Doane / ; E J Doherty / ; T S Han / ; I A Hughes / ; S Hunter / ; V Ibbotson / ; N Karavitaki / ; N Krone / ; J MacDonald / ; K Mullen / ; S Peacey / ; C Perry / ; D W Ray / ; R J M Ross / ; D A Rees / ; M Scanlon / ; H Simpson / ; P M Stewart / ; S E Stewart / ; R H Stimson / ; J P Vora / ; D Wake / ; E Walker / ; B R Walker / ; J A H Wass / ; P Whittingham / ; S Wild / ; D S Willis / ; D Wright / ; F C Wu /

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