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Cited by 70Sexual Differentiation and DisordersAdrenal Hormones and DisordersOvarian function and disorders

Glucocorticoid treatment regimen and health outcomes in adults with congenital adrenal hyperplasia

Han, T. S., Stimson, R. H., Rees, D. A., Krone, N., Willis, D. S., Conway, G. S., Arlt, W., Walker, B. R. +2 more·2013·Clinical Endocrinology
DOI 10.1111/cen.12045
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Abstract

Summary: 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 (F3,141 = 4·4, P < 0·01). In PCA, 3 PCs were identified that explained 62% of the total variance (r2) 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 (r2 = 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.

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Authors
Han, T. S., Stimson, R. H., Rees, D. A., Krone, N., Willis, D. S., Conway, G. S., Arlt, W., Walker, B. R., Ross, R. J., & (CaHASE), U. K. C. A. H. A. S. E.
Affiliations
  • University College Hospital (GB)
  • The Queen's Medical Research Institute (GB)
  • Centre for Endocrine and Diabetes Sciences Institute for Molecular and Experimental Medicine Cardiff University Cardiff UK
  • University of Birmingham (GB)
  • Society for Endocrinology (GB)
  • University of Sheffield (GB)
Corresponding author
Ross, R. J.
ORCID
Venue
Clinical Endocrinology
Publisher
Wiley
Published
2013-01-07
Volume
78
Issue
2
Pages
197-203
ISSN
  • 0300-0664 (ISSN-L)
  • 1365-2265
DOI
10.1111/cen.12045
OpenAlex
W2097310478
Cited by
70
References
30
Citations by year
2026: 6 · 2025: 3 · 2024: 5 · 2023: 5 · 2022: 4 · 2021: 6 · 2020: 4 · 2019: 5 · 2018: 2 · 2017: 1 · 2016: 8 · 2015: 4 · 2014: 10 · 2013: 7
FWCI
2.70
Type
journal article
Language
en
Open access
closed
Licence
onlinelibrary.wiley.com/termsAndConditions#vor (vor)
Locations
  • Clinical Endocrinology (publishedVersion)
  • PubMed (publishedVersion)
  • UCL Discovery (University College London) (submittedVersion)
  • ORCA Online Research @Cardiff (Cardiff University) (submittedVersion)
  • University of Birmingham Research Portal (University of Birmingham) (submittedVersion)
Funders
  • National Institute for Health and Care Research (NF-SI-0508-10356)
  • British Heart Foundation (RG/11/4/28734)
Topics
  • Life Sciences › Biochemistry, Genetics and Molecular Biology › Molecular Biology › Sexual Differentiation and Disorders
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Adrenal Hormones and Disorders
  • Health Sciences › Medicine › Reproductive Medicine › Ovarian function and disorders
Keywords
congenital adrenal hyperplasia, dexamethasone, cortisol, prednisolone, insulin resistance, blood pressure, androgen levels, ACTH, mutation severity, disease control, adult patients
MeSH terms
Adrenal Hyperplasia, Congenital, Adult, Cross-Sectional Studies, Dexamethasone, Drug Therapy, Combination, Energy Metabolism, Female, Humans, Hydrocortisone, Male, Middle Aged, Young Adult

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