Alterations in Lipid and Carbohydrate Metabolism in Patients with Classic Congenital Adrenal Hyperplasia due to 21-Hydroxylase Deficiency

作者：Zimmermann Anca^*; Grigorescu Sido Paula; AlKhzouz Camelia; Patberg Karen; Bucerzan Simona; Schulze Egbert; Zimmermann Tim; Rossmann Heidi; Geiss Hans Christian; Lackner Karl J; Weber Matthias M

来源：Hormone Research in Paediatrics, 2010, 74(1): 41-49.

DOI：10.1159/000313368

• 21-Hydroxylase
• Small-dense low-density lipoproteins
• Atherogenesis

Background: Classic 21-hydroxylase deficiency (21HD) presents some traits of the metabolic syndrome. Aim: To characterize discrete alterations of lipid and carbohydrate metabolism in children and young adults with classic 21HD, which could predict early atherogenesis. Patients and Methods: Twenty-seven Caucasian patients with classic 21HD (4-31 years); 27 sex-, age-and BMI-matched controls. Clinical parameters, hormonal status and genotype were assessed in all patients. Lipid parameters, including relative (%) and absolute (mg/dl) small-dense low-density lipoproteins subfractions (sd-LDL) were measured in patients and controls. Oral glucose tolerance tests were performed in both groups. Results: sd-LDL (%) was significantly higher in patients than controls (39.7 +/- 5.9 vs. 35.5 +/- 5.7%; p = 0.008). The same applies for absolute sd-LDL (mg/dl) (42.6 +/- 11.9 vs. 36.4 +/- 7.5; p = 0.029). HDL-cholesterol was lower in patients (p = 0.032). Fasting glucose and insulin were significantly higher in patients. Similar differences were noticed for HOMA-IR (p = 0.001), IRI (p = 0.001) and HOMA-B (p = 0.002). IRI correlated directly and significantly with the total hydrocortisone dose and the duration of treatment. Fasting glucose correlated with absolute sd-LDL. No obvious differences were seen between clinical forms or genotype groups. Conclusions: Substitution therapy should be adapted particularly at young ages to prevent early atherogenesis and cardiovascular risk in later life.

• 出版日期2010