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DOI: 10.1055/s-0034-1372078
Early metabolic alterations and cardiovascular risk in patients with classic congenital adrenal hyperplasia (CAH). Are they reversible by life-style intervention?
Introduction: Traits of metabolic syndrome (MS) were reported in patients with classic CAH.
Aim: To investigate early potentially atherogenic metabolic alterations and check their reversibility under life style intervention (LSI).
Patients/methods: 39 patients, classic CAH (M/F26/14, 14.1+/-9.1ys). Physical examination, anthropometric parameters were documented. We measured routine hormonal and lipid parameters, LDL subfractions, adipokines, parameters of oxidative stress/subclinical inflammation and carotis intima-media thickness in comparison to a matched healthy control group. Patients with traits of MS were subjected to 12 months LSI with dietary/psychological counselling and increased physical activity. Clinical, metabolic and psychological reevaluation was performed after 6 and 12 months.
Results: Baseline triglycerides (TG), small dense LDL, chemerin (Che), oxidized LDL and fasting glucose were significantly increased, IL-6, PAI1 and hsCRP were lower in patients than controls, HOMA-IR and IRI were significantly higher. Patients with at least two metabolic abnormalities were selected (n = 21) and subjected to LSI. Overweight/obesity was observed in 9/39 patients (23%). Of those, two patients achieved normal weight during LSI. In children, we noticed after LSI a significant decrease of total cholesterin (p = 0.03), TG (p = 0.05), Che (p = 0.03), resistin (R) (p = 0.04), PAI-1 (p = 0.009), hsCRP. In adults, HDL-cholesterin increased (p = 0.012), TGs decreased (p = 0.019), fasting glucose, HOMA-IR and IRI decreased (p = 0.006;0.031;0.022), R and Che decreased (p = 0.008;< 0.001), oxidized LDL and PAI-1 decreased (p = 0.05;0.013). In all patients with a successful weight response, HDL-cholesterin increased, TG, fasting insulin, HOMA-IR, IRI, R, Che, PAI-1 decreased. Psychological testing showed an improvement of well-being, self-confidence, stress coping, body-image.
Conclusions: LSI had positive metabolic and psychological effects, independent of treatment variables.