Exp Clin Endocrinol Diabetes 2007; 115 - P02_136
DOI: 10.1055/s-2007-972543

Evidence for insulin resistance in children and adolescents with classical congenital adrenal hyperplasia due to 21-hydroxylase deficiency (CAH)

TMK Völkl 1, D Simm 1, M Rauh 1, HG Dörr 1
  • 1Kinder- und Jugendklinik der Friedrich-Alexander-Universität Erlangen-Nürnberg, Pädiatrische Endokrinologie, Erlangen, Germany

Objective: Overweight and obesity are known as main risk factor for insulin resistance. CAH patients tend to be obese, and there are few reports on higher insulin levels. Therefore, the aim of our study was to analyze serum lipids and insulin resistance and the impact of different parameters such as body-mass index (BMI), and glucocorticoid dosage.

Patients and methods: A total of n=54 subjects, aged between 5.3 and 19.0 years (median 11.9, n=31 females) were studied cross-sectionally. All patients had genetically proven CAH (salt wasting: n=44; simple virilizing: n=10) and received standard steroid substitution therapy. Blood specimens were taken after overnight fasting between 08:00 and 10:00 am. We measured serum levels of total insulin and glucose by commercial RIA/ELISA. We calculated the HOMA-IR ratio.

Results: (median, range) BMI SDS were significantly different from zero (1.09 SDS, -2.45 to 3.77; p<0.001). Glucose (80%, 68 to 103) and HbA1c (5.65%, 4.7 to 6.3) values showed to be normal, whereas insulin levels were elevated (12.7µU/mL, 2.80 to 31.4), resulting in an elevated HOMA-IR ratio (2.65, 0.55 to 5.81, >2.0 for p<0.0001). 24 (n=14 females) out of 54 patients (44%) had a HOMA-IR over 3.0 (borderline); 13 (n=5 females) out of 54 (24%) over 4.0 (pathological). Correlation analyses revealed significant correlations between BMI SDS with serum insulin (rs=0.305, p=0.0249) as well as HOMA-IR (rs=0.305, p=0.0248). There was no correlation with equivalent hydrocortisone and fludrocortisone dosage, and between males and females.

Conclusions: There is evidence for an elevated risk of obesity and consecutive insulin resistance in children and adolescents with CAH. Thus, weight control should be a main part in the management of CAH.