Cardiac function in children with congenital adrenal hyperplasia

Tuğba Kontbay Çetin; Abdulkadir Akkuş; Müge Atar

doi:10.1515/jpem-2025-0037

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Cardiac function in children with congenital adrenal hyperplasia

Tuğba Kontbay Çetin , Abdulkadir Akkuş und Müge Atar

Veröffentlicht/Copyright: 8. April 2025

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Aus der Zeitschrift Journal of Pediatric Endocrinology and Metabolism Band 38 Heft 6

Abstract

Objectives

Glucocorticoid excess or deficiency with hyperandrogenism may cause cardiovascular morbidity in patients with congenital adrenal hyperplasia (CAH) due to failing to mimic physiological circadian rhythm. This study aimed to evaluate the cardiac function in pediatric patients with CAH treated with conventional hydrocortisone treatment and its relation to hydrocortisone dose and therapy duration.

Methods

Twenty-three pediatric patients with CAH, aged 3–16 years, and 21 age- and gender-matched healthy controls were enrolled to the study. All the patients were evaluated by physical examination, electrocardiogram (ECG), conventional echocardiography, and tissue Doppler imaging (TDI).

Results

The mean Sm (systolic myocardial velocity) in the CAH group was 7.96 ± 1.22 cm/s, which was significantly lower than that in the control group (p=0.034). The mean systolic excursion in the CAH group was 14.17 ± 1.92 mm, which was significantly lower than that in the control group (p=0.046). The tricuspid-derived early diastolic myocardial velocity (Em) and the tricuspid-derived E/Em ratio were significantly higher in the CAH group than in the control group (p=0.003 and 0.008, respectively). No signs of left ventricular hypertrophy or dilatation were detected on ECG and echocardiography.

Conclusions

Long-term conventional hydrocortisone therapy even within the recommended therapeutic range may adversely affect cardiac functions in children with 21-hydroxylase deficiency.

Keywords: M-mode echocardiography; adrenal insufficiency; hydrocortisone treatment

Corresponding author: Tuğba Kontbay Çetin, Department of Paediatric Endocrinology, Şanlıurfa Training and Research Hospital, Lise Caddesi, Adalet Mahallesi, Doğumevi, 55000 İlkadım, Şanlıurfa, Türkiye; and Department of Paediatric Endocrinology, Samsun Training and Research Hospital, Samsun, Türkiye, E-mail: tugbakontbay@gmail.com

Acknowledgments

We would like to thank Dr İhsan Turan for his dedicated work in establishing the genetic diagnosis and follow-up of patients diagnosed with congenital adrenal hyperplasia.

Research ethics: The study was approved by the local Ethics Committee of Harran University Ethics Committee (approval number: E.4912). The study was conducted in accordance with the Declaration of Helsinki (as revised in 2013).
Informed consent: Informed consent was obtained from all individuals included in this study, or their legal guardians or wards.
Author contributions: All authors have accepted responsibility for the entire content of this manuscript and approved its submission.
Use of Large Language Models, AI and Machine Learning Tools: None declared.
Conflict of interest: The authors state no conflict of interest.
Research funding: None declared.
Data availability: Not applicable.

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Received: 2025-01-17

Accepted: 2025-03-17

Published Online: 2025-04-08

Published in Print: 2025-06-26

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https://doi.org/10.1515/jpem-2025-0037

Schlagwörter für diesen Artikel

M-mode echocardiography; adrenal insufficiency; hydrocortisone treatment