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Prevalence of metabolic syndrome according to different metabolic syndrome definitions in children and adolescents with congenital adrenal hyperplasia: a single center study

Year 2018, Volume: 9 Issue: 3, 166 - 172, 30.09.2018
https://doi.org/10.18663/tjcl.437819

Abstract

Aim: The aim
of this study was to investigate the prevalence of metabolic syndrome according
to different metabolic syndrome definitions in children and adolescents with
congenital adrenal hyperplasia due to 21-hydroxylase deficiency. 

Material and Methods: A total number of 45 patients (31
patients with classical congenital adrenal hyperplasia due to 21-hydroxylase
deficiency and 14 patients with non-classical congenital adrenal hyperplasia)
were enrolled to the study. The anthropometric, clinical, hormonal findings and
the dose of hydrocortisone were analyzed starting from the initial day of
diagnosis until the beginning of our study and the metabolic controls
(good-bad) were evaluated in the follow-up period. At the last visit, systemic
and anthropometric examinations (involving measures of height, weight, waist
circumference and blood pressure) was performed by the same physician. Serum
lipid levels were examined and oral glucose tolerance tests were performed.
Metabolic syndrome prevalence in our patients was calculated with respect to
the modified criteria of WHO, IDF and NCEP ATP III. 


Results: Metabolic syndrome was diagnosed in
only 1 (2.2%) of the 45 patients in the study according to modified WHO
definition, 8 patients (17.8%) received a diagnosis of metabolic syndrome
according to NCEP ATP III definition. Metabolic syndrome was diagnosed in 1
(3.3%) of 30 patients above 10 years of age according to IDF definition and 20%
of patients aged 6-10 years were considered to be risky for development of
metabolic syndrome. Conclusion: It
was found that the prevalence of metabolic syndrome was highest when NCEP ATP
III definition was used.

References

  • 1. Speiser PW, Azziz R, Baskin LS et al. Endocrine Society. Congenital adrenal hyperplasia due to steroid 21-hydroxylase deficiency: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab 2010; 95: 4133-60.
  • 2. Yanase T, Tajima T, Katabami T et al. Diagnosis and treatment of adrenal insufficiency including adrenal crisis: a Japan Endocrine Society clinical practice guideline [Opinion]. Endocr J 2016; 63: 765-84.
  • 3. Schnaider-Rezek GS, Lemos-Marini SH, Baptista MT, et al. Metabolic evaluation of young women with congenital adrenal hyperplasia. Arq Bras Endocrinol Metabol 2011; 55: 646-52.
  • 4. Charmandari E, Chrousos GP. Metabolic syndrome manifestations in classic congenital adrenal hyperplasia: do they predispose to atherosclerotic cardiovascular disease and secondary polycistic ovary syndrome?. Ann N Y Acad Sci 2006; 1083: 37-53.
  • 5. Finkielstain GP, Kim MS, Sinaii N et al. Clinical characteristics of a cohort of 244 patients with congenital adrenal hyperplasia. J Clin Endocrinol Metab 2012; 97: 4429-38.
  • 6. Moreira RP, Villares SM, Madureira G, Mendonca BB, Bachega TA. Obesity and familial predisposition are significant determining factors of an adverse metabolic profile in young patients with congenital adrenal hyperplasia. Horm Res Paediatr 2013; 80: 111-18.
  • 7. Schnaider-Rezek GS, Lemos-Marini SH, Baptista MT et al. Metabolic evaluation of young women with congenital adrenal hyperplasia. Arq Bras Endocrinol Metabol 2011; 55: 646-52.
  • 8. Neyzi O, Günöz H, Furman A et al. Weight, height, head circumference and body mass index references for Turkish children. Çocuk Sağlığı ve Hastalıkları Dergisi 2008; 51: 1-14.
  • 9. Hatipoğlu N, Mazicioğlu MM, Poyrazoğlu S, Borlu A, Horoz D, Kurtoğlu S. Waist circumference percentiles among Turkish children under the age of 6 years. Eur J Pediatr 2013; 172: 59-69.
  • 10. National High Blood Pressure Education Program Working Group on High Blood Pressure in Children and Adolescents. The fourth report on the diagnosis, evaluation, and treatment of high blood pressure in children and adolescents. Pediatrics 2004; 114; 555-76.
  • 11. Anderson M. Use of the Greulich-Pyle "Atlas of Skeletal Development of the Hand and Wrist" in a clinical context. Am J Phys Anthropol 1971; 35: 347-52.
  • 12. Girgis R, Winter JS. The effects of glucocorticoid replacement therapy on growth, bone mineral density, and bone turnover markers in children with congenital adrenal hyperplasia. J Clin Endocrinol Metab 1997; 82: 3926-29.
  • 13. Bode HH, Rivkees SA, Cowley DM, Pardy K, Johnson S. Home monitoring of 17 hydroxyprogesterone levels in congenitx127drenal hyperplasia with filterpaper blood samples. J Pediatr 1999; 134: 185-89.
  • 14. Kurtoğlu S, Hatipoğlu N, Mazıcıoğlu M, Kendirici M, Keskin M, Kondolot M. Insulin resistance in obese children and adolescents: HOMA-IR cut-off levels in the prepubertal and pubertal periods. J Clin Res Pediatr Endocrinol 2010; 2: 100-6.
  • 15. Reinehr T, de Sousa G, Toschke AM, Andler W. Comparison of metabolic syndrome prevalence using eight different definitions: a critical approach. Arch Dis Child 2007; 92: 1067-72.
  • 16. Şıklar Z. Çocuk ve adolesanlarda obezite komplikasyonları ve metabolik sendrom. Türkiye Çocuk Hast Derg 2012; 2: 48-58.
  • 17. Mooij CF, Kroese JM, Claahsen-van der Grinten HL, Tack CJ, Hermus AR. Unfavourable trends in cardiovascular and metabolic risk in paediatric and adult patients with congenital adrenal hyperplasia? Clin Endocrinol (Oxf) 2010; 73: 137-46.
  • 18. Zhang HJ, Yang J, Zhang MN et al. Metabolic disorders in newly diagnosed young adult female patients with simple virilizing 21-hydroxylase deficiency. Endocrine 2010; 38: 260-65.
  • 19. Reisch N, Arlt W, Krone N. Health problems in congenital adrenal hyperplasia due to 21-hydroxylase deficiency. Horm Res Paediatr 2011; 76: 73-85.
  • 20. Völkl TM, Simm D, Beier C, Dörr HG. Obesity among children and adolescents with classic congenital adrenal hyperplasia due to 21-hydroxylase deficiency. Pediatrics 2006; 117: 98-105.
  • 21. Cornean RE, Hindmarsh PC, Brook CG. Obesity in 21-hydroxylase deficient patients. Arch Dis Child 1998; 78: 261-63.
  • 22. Stikkelbroeck NM, Oyen WJ, van der Wilt GJ, Hermus AR, Otten BJ. Normal bone mineral density and lean body mass, but increased fat mass, in young adult patients with congenital adrenal hyperplasia. J Clin Endocrinol Metab 2003; 88: 1036-42.
  • 23. Völkl TM, Simm D, Körner A et al. Does an altered leptin axis play a role in obesity among children and adolescents with classical congenital adrenal hyperplasia due to 21-hydroxylase deficiency?. Eur J Endocrinol 2009; 160: 239-247.
  • 24. Charmandari E, Weise M, Bornstein SR et al. Children with classic congenital adrenal hyperplasia have elevated serum leptin concentrations and insulin resistance: potential clinical implications. J Clin Endocrinol Metab 2002; 87: 2114-20.
  • 25. Botero D, Arango A, Danon M, Lifshitz F. Lipid profile in congenital adrenal hyperplasia. Metabolism 2000; 49: 790-93.
  • 26. Roche EF, Charmandari E, Dattani MT, Hindmarsh PC. Blood pressure in children and adolescents with congenital adrenal hyperplasia (21-hydroxylase deficiency): a preliminary report. Clin Endocrinol (Oxf) 2003; 58: 589-96.
  • 27. Nebesio TD, Eugster EA. Observation of hypertension in children with 21-hydroxylase deficiency: a preliminary report. Endocrine 2006; 30: 279-82.
  • 28. Subbarayan A, Dattani MT, Peters CJ, Hindmarsh PC. Cardiovascular risk factors in children and adolescents with congenital adrenal hyperplasia due to 21-hydroxylase deficiency. Clin Endocrinol (Oxf) 2014; 80: 471-77.
  • 29. Bonfig W, Roehl FW, Riedl S et al. AQUAPE CAH Study Group. Blood Pressure in a Large Cohort of Children and Adolescents With Classic Adrenal Hyperplasia (CAH) Due to 21-Hydroxylase Deficiency. Am J Hypertens 2016; 29: 266-72.
  • 30. Lee L, Sanders RA. Metabolic syndrome. Pediatr Rev 2012; 33: 459-66.
  • 31. Moreira RP, Gomes LG, Mendonca BB, Bachega TA. Impact of glucocorticoid receptor gene polymorphisms on the metabolic profile of adult patients with the classical form of 21-hydroxylase deficiency. PLoSOne 2012; 7: 44893.

Konjenital adrenal hiperplazi tanılı çocuk ve adolesanlarda farklı metabolik sendrom tanı kriterlerine göre metabolik sendrom sıklığı: tek merkez çalışması

Year 2018, Volume: 9 Issue: 3, 166 - 172, 30.09.2018
https://doi.org/10.18663/tjcl.437819

Abstract

Amaç: Çalışmanın amacı 21
hidroksilaz eksikliğine bağlı konjenital adrenal hiperplazi tanısı olan çocuk
ve adolesanlarda farklı metabolik sendrom tanı kriterlerine göre metabolik
sendrom prevelansını belirlemektir.


Gereç ve Yöntemler: Çalışmaya konjenital adrenal hiperplazisi tanısı olan toplam 45 hasta (21
hidroksilaz eksikliğine bağlı klasik konjenital adrenal hiperplazi tanısı olan
31 hasta, non klasik konjenital adrenal hiperplazi tanısı alan 14 hasta) dahil
edildi. Hastaların antropometrik ölçümleri, klinik
değerlendirmeleri, hormonal sonuçları ve hidrokortizon dozu tanı anından
çalışmanın başladığı tarihe kadar incelendi ve izlemdeki metabolik durumları
(iyi-kötü) belirlenen kriterlere göre değerlendirildi. Son vizitte, hastaların
sistemik ve antropometrik değerlendirmeleri (boy,
kilo, bel çevresi ve kan basıncı ölçümlerini içeren) aynı tecrübeli klinisyen
tarafından yapıldı. Hastaların serum lipid düzeyleri ölçüldü ve hastalara oral
glukoz tolerans testi uygulandı. WHO, IDF ve NCEP ATP III modifiye kriterlerine göre metabolik sendrom prevalansı hesaplandı.


Bulgular: Çalışmamızda modifiye WHO kriterlerine göre yalnızca 1
(2,2%) hastada, NCEP ATP III kriterlerine göre ise 8 (17,8%) hastaya metabolik
sendrom tanısı konuldu. IDF kriterlerine göre 10 yaş üstü 30 hastadan 1’ine (3,3%) metabolik sendrom tanısı konulur
iken 6-10 yaş arası hastaların 20%’ sinin metabolik sendrom gelişimi
için risk altında olduğu saptandı.








Sonuç: Konjenital adrenal
hiperplazi tanılı çocuk ve adolesan hastalarda NCEP ATP III metabolik sendrom tanı kriterleri kullanıldığında en yüksek oranda
metabolik sendrom sıklığı saptanmıştır.

References

  • 1. Speiser PW, Azziz R, Baskin LS et al. Endocrine Society. Congenital adrenal hyperplasia due to steroid 21-hydroxylase deficiency: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab 2010; 95: 4133-60.
  • 2. Yanase T, Tajima T, Katabami T et al. Diagnosis and treatment of adrenal insufficiency including adrenal crisis: a Japan Endocrine Society clinical practice guideline [Opinion]. Endocr J 2016; 63: 765-84.
  • 3. Schnaider-Rezek GS, Lemos-Marini SH, Baptista MT, et al. Metabolic evaluation of young women with congenital adrenal hyperplasia. Arq Bras Endocrinol Metabol 2011; 55: 646-52.
  • 4. Charmandari E, Chrousos GP. Metabolic syndrome manifestations in classic congenital adrenal hyperplasia: do they predispose to atherosclerotic cardiovascular disease and secondary polycistic ovary syndrome?. Ann N Y Acad Sci 2006; 1083: 37-53.
  • 5. Finkielstain GP, Kim MS, Sinaii N et al. Clinical characteristics of a cohort of 244 patients with congenital adrenal hyperplasia. J Clin Endocrinol Metab 2012; 97: 4429-38.
  • 6. Moreira RP, Villares SM, Madureira G, Mendonca BB, Bachega TA. Obesity and familial predisposition are significant determining factors of an adverse metabolic profile in young patients with congenital adrenal hyperplasia. Horm Res Paediatr 2013; 80: 111-18.
  • 7. Schnaider-Rezek GS, Lemos-Marini SH, Baptista MT et al. Metabolic evaluation of young women with congenital adrenal hyperplasia. Arq Bras Endocrinol Metabol 2011; 55: 646-52.
  • 8. Neyzi O, Günöz H, Furman A et al. Weight, height, head circumference and body mass index references for Turkish children. Çocuk Sağlığı ve Hastalıkları Dergisi 2008; 51: 1-14.
  • 9. Hatipoğlu N, Mazicioğlu MM, Poyrazoğlu S, Borlu A, Horoz D, Kurtoğlu S. Waist circumference percentiles among Turkish children under the age of 6 years. Eur J Pediatr 2013; 172: 59-69.
  • 10. National High Blood Pressure Education Program Working Group on High Blood Pressure in Children and Adolescents. The fourth report on the diagnosis, evaluation, and treatment of high blood pressure in children and adolescents. Pediatrics 2004; 114; 555-76.
  • 11. Anderson M. Use of the Greulich-Pyle "Atlas of Skeletal Development of the Hand and Wrist" in a clinical context. Am J Phys Anthropol 1971; 35: 347-52.
  • 12. Girgis R, Winter JS. The effects of glucocorticoid replacement therapy on growth, bone mineral density, and bone turnover markers in children with congenital adrenal hyperplasia. J Clin Endocrinol Metab 1997; 82: 3926-29.
  • 13. Bode HH, Rivkees SA, Cowley DM, Pardy K, Johnson S. Home monitoring of 17 hydroxyprogesterone levels in congenitx127drenal hyperplasia with filterpaper blood samples. J Pediatr 1999; 134: 185-89.
  • 14. Kurtoğlu S, Hatipoğlu N, Mazıcıoğlu M, Kendirici M, Keskin M, Kondolot M. Insulin resistance in obese children and adolescents: HOMA-IR cut-off levels in the prepubertal and pubertal periods. J Clin Res Pediatr Endocrinol 2010; 2: 100-6.
  • 15. Reinehr T, de Sousa G, Toschke AM, Andler W. Comparison of metabolic syndrome prevalence using eight different definitions: a critical approach. Arch Dis Child 2007; 92: 1067-72.
  • 16. Şıklar Z. Çocuk ve adolesanlarda obezite komplikasyonları ve metabolik sendrom. Türkiye Çocuk Hast Derg 2012; 2: 48-58.
  • 17. Mooij CF, Kroese JM, Claahsen-van der Grinten HL, Tack CJ, Hermus AR. Unfavourable trends in cardiovascular and metabolic risk in paediatric and adult patients with congenital adrenal hyperplasia? Clin Endocrinol (Oxf) 2010; 73: 137-46.
  • 18. Zhang HJ, Yang J, Zhang MN et al. Metabolic disorders in newly diagnosed young adult female patients with simple virilizing 21-hydroxylase deficiency. Endocrine 2010; 38: 260-65.
  • 19. Reisch N, Arlt W, Krone N. Health problems in congenital adrenal hyperplasia due to 21-hydroxylase deficiency. Horm Res Paediatr 2011; 76: 73-85.
  • 20. Völkl TM, Simm D, Beier C, Dörr HG. Obesity among children and adolescents with classic congenital adrenal hyperplasia due to 21-hydroxylase deficiency. Pediatrics 2006; 117: 98-105.
  • 21. Cornean RE, Hindmarsh PC, Brook CG. Obesity in 21-hydroxylase deficient patients. Arch Dis Child 1998; 78: 261-63.
  • 22. Stikkelbroeck NM, Oyen WJ, van der Wilt GJ, Hermus AR, Otten BJ. Normal bone mineral density and lean body mass, but increased fat mass, in young adult patients with congenital adrenal hyperplasia. J Clin Endocrinol Metab 2003; 88: 1036-42.
  • 23. Völkl TM, Simm D, Körner A et al. Does an altered leptin axis play a role in obesity among children and adolescents with classical congenital adrenal hyperplasia due to 21-hydroxylase deficiency?. Eur J Endocrinol 2009; 160: 239-247.
  • 24. Charmandari E, Weise M, Bornstein SR et al. Children with classic congenital adrenal hyperplasia have elevated serum leptin concentrations and insulin resistance: potential clinical implications. J Clin Endocrinol Metab 2002; 87: 2114-20.
  • 25. Botero D, Arango A, Danon M, Lifshitz F. Lipid profile in congenital adrenal hyperplasia. Metabolism 2000; 49: 790-93.
  • 26. Roche EF, Charmandari E, Dattani MT, Hindmarsh PC. Blood pressure in children and adolescents with congenital adrenal hyperplasia (21-hydroxylase deficiency): a preliminary report. Clin Endocrinol (Oxf) 2003; 58: 589-96.
  • 27. Nebesio TD, Eugster EA. Observation of hypertension in children with 21-hydroxylase deficiency: a preliminary report. Endocrine 2006; 30: 279-82.
  • 28. Subbarayan A, Dattani MT, Peters CJ, Hindmarsh PC. Cardiovascular risk factors in children and adolescents with congenital adrenal hyperplasia due to 21-hydroxylase deficiency. Clin Endocrinol (Oxf) 2014; 80: 471-77.
  • 29. Bonfig W, Roehl FW, Riedl S et al. AQUAPE CAH Study Group. Blood Pressure in a Large Cohort of Children and Adolescents With Classic Adrenal Hyperplasia (CAH) Due to 21-Hydroxylase Deficiency. Am J Hypertens 2016; 29: 266-72.
  • 30. Lee L, Sanders RA. Metabolic syndrome. Pediatr Rev 2012; 33: 459-66.
  • 31. Moreira RP, Gomes LG, Mendonca BB, Bachega TA. Impact of glucocorticoid receptor gene polymorphisms on the metabolic profile of adult patients with the classical form of 21-hydroxylase deficiency. PLoSOne 2012; 7: 44893.
There are 31 citations in total.

Details

Primary Language English
Subjects Health Care Administration
Journal Section Orıgınal Artıcle
Authors

Pelin Celik Babalıoğlu This is me

Melikşah Keskin

Zehra Aycan

Publication Date September 30, 2018
Published in Issue Year 2018 Volume: 9 Issue: 3

Cite

APA Celik Babalıoğlu, P., Keskin, M., & Aycan, Z. (2018). Prevalence of metabolic syndrome according to different metabolic syndrome definitions in children and adolescents with congenital adrenal hyperplasia: a single center study. Turkish Journal of Clinics and Laboratory, 9(3), 166-172. https://doi.org/10.18663/tjcl.437819
AMA Celik Babalıoğlu P, Keskin M, Aycan Z. Prevalence of metabolic syndrome according to different metabolic syndrome definitions in children and adolescents with congenital adrenal hyperplasia: a single center study. TJCL. September 2018;9(3):166-172. doi:10.18663/tjcl.437819
Chicago Celik Babalıoğlu, Pelin, Melikşah Keskin, and Zehra Aycan. “Prevalence of Metabolic Syndrome According to Different Metabolic Syndrome Definitions in Children and Adolescents With Congenital Adrenal Hyperplasia: A Single Center Study”. Turkish Journal of Clinics and Laboratory 9, no. 3 (September 2018): 166-72. https://doi.org/10.18663/tjcl.437819.
EndNote Celik Babalıoğlu P, Keskin M, Aycan Z (September 1, 2018) Prevalence of metabolic syndrome according to different metabolic syndrome definitions in children and adolescents with congenital adrenal hyperplasia: a single center study. Turkish Journal of Clinics and Laboratory 9 3 166–172.
IEEE P. Celik Babalıoğlu, M. Keskin, and Z. Aycan, “Prevalence of metabolic syndrome according to different metabolic syndrome definitions in children and adolescents with congenital adrenal hyperplasia: a single center study”, TJCL, vol. 9, no. 3, pp. 166–172, 2018, doi: 10.18663/tjcl.437819.
ISNAD Celik Babalıoğlu, Pelin et al. “Prevalence of Metabolic Syndrome According to Different Metabolic Syndrome Definitions in Children and Adolescents With Congenital Adrenal Hyperplasia: A Single Center Study”. Turkish Journal of Clinics and Laboratory 9/3 (September 2018), 166-172. https://doi.org/10.18663/tjcl.437819.
JAMA Celik Babalıoğlu P, Keskin M, Aycan Z. Prevalence of metabolic syndrome according to different metabolic syndrome definitions in children and adolescents with congenital adrenal hyperplasia: a single center study. TJCL. 2018;9:166–172.
MLA Celik Babalıoğlu, Pelin et al. “Prevalence of Metabolic Syndrome According to Different Metabolic Syndrome Definitions in Children and Adolescents With Congenital Adrenal Hyperplasia: A Single Center Study”. Turkish Journal of Clinics and Laboratory, vol. 9, no. 3, 2018, pp. 166-72, doi:10.18663/tjcl.437819.
Vancouver Celik Babalıoğlu P, Keskin M, Aycan Z. Prevalence of metabolic syndrome according to different metabolic syndrome definitions in children and adolescents with congenital adrenal hyperplasia: a single center study. TJCL. 2018;9(3):166-72.


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