Cardiovascular risk factors and ultrasound evaluation of intima-media thickness at common carotids, carotid bulbs, and femoral and abdominal aorta arteries in patients with classic congenital adrenal hyperplasia due to 21-hydroxylase deficiency

Context: In congenital adrenal hyperplasia ( CAH) due to 21-hydroxylase deficiency, a tendency for obesity, high insulin, and high 24-h blood pressure levels has been reported in children and adolescents. Increased intima-media thickness ( IMT) is considered a measure of subclinical atherosclerosis and a predictor of myocardial infarction and stroke. Objective: The objective of the study was to evaluate glucose metabolism, lipid profile, IMT of the abdominal aorta, right and left common carotids, carotid bulbs, and common femoral arteries in adult CAH patients. Subjects: Nineteen ( 10 females, nine males; 28 +/- 3.5 yr) patients ( 12 salt wasting and seven simple virilizing) and 19 ( 10 females, nine males) healthy subjects matched for anthropometric parameters ( age, sex, body mass index, smoking habit, waist to hip ratio, and blood pressure). Methods: Glucose metabolism was studied using the oral glucose tolerance test and the homeostasis model assessment-insulin resistance. The echo-Doppler was used for arterial ultrasound. 17-Hydroxyprogesterone, androstenedione, testosterone, ACTH, plasma renin activity, total and high-density lipoprotein cholesterol, and triglycerides were measured. Results: CAH patients had significantly higher fasting plasma insulin ( 11.6 +/- 6.20 mu U/ml vs 5.18 +/- 2.4 mu U/ml; P < 0.0001) and homeostasis model assessment-insulin resistance than controls ( 2.46 +/- 1.92 vs 1.12 +/- 0.58; P = 0.0033). IMT of the studied arteries was higher in CAH patients than controls. There was no correlation between IMT and cumulative glucocorticoid doses and androgen levels. Conclusion: A reduced insulin sensitivity and increased IMT were demonstrated in adults with CAH, who consequently need a follow-up for cardiovascular risk.