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Impaired systolic and diastolic left ventricular function in children and adolescents with congenital adrenal hyperplasia receiving corticosteroid therapy

Published online by Cambridge University Press:  24 January 2019

Hale Tuhan Open the ORCID record for Hale Tuhan [Opens in a new window] ,
Tülay Demircan ,
Ayca Altıncık ,
Gönül Çatlı ,
Özgür Kızılca ,
Tuğba Egeli ,
Mustafa Kır ,
Şule Can ,
Bumin Dündar  and
Ece Böber
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Hale Tuhan*
Affiliation:
Department of Pediatric Endocrinology, Dokuz Eylül University, Faculty of Medicine, Izmir, Turkey
Tülay Demircan
Affiliation:
Department of Pediatric Cardiology, Dokuz Eylül University, Faculty of Medicine, Izmir, Turkey
Ayca Altıncık
Affiliation:
Pediatric Endocrinology Unit, State Hospital of Denizli, Denizli, Turkey
Gönül Çatlı
Affiliation:
Department of Pediatric Endocrinology, Izmir Katip Celebi University, Faculty of Medicine, Izmir, Turkey
Özgür Kızılca
Affiliation:
Department of Pediatric Cardiology, Dokuz Eylül University, Faculty of Medicine, Izmir, Turkey
Tuğba Egeli
Affiliation:
Department of Pediatric Endocrinology, Dokuz Eylül University, Faculty of Medicine, Izmir, Turkey
Mustafa Kır
Affiliation:
Department of Pediatric Cardiology, Dokuz Eylül University, Faculty of Medicine, Izmir, Turkey
Şule Can
Affiliation:
Division of Pediatric Endocrinology, Tepecik Training and Research Hospital, Izmir, Turkey
Bumin Dündar
Affiliation:
Department of Pediatric Endocrinology, Izmir Katip Celebi University, Faculty of Medicine, Izmir, Turkey
Ece Böber
Affiliation:
Department of Pediatric Endocrinology, Dokuz Eylül University, Faculty of Medicine, Izmir, Turkey
Ayhan Abacı
Affiliation:
Department of Pediatric Endocrinology, Dokuz Eylül University, Faculty of Medicine, Izmir, Turkey
*
Author for correspondence: H. Tuhan, MD, Department of Pediatric Endocrinology, Dokuz Eylul University, Faculty of Medicine, Balcova, Izmir 35340, Turkey. Tel: +90 232 4126080; Fax: +90 232 4126001; E-mail: halenvr@hotmail.com
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Abstract

Aim

The present study aimed to evaluate systolic and diastolic myocardial function in children and adolescents with congenital adrenal hyperplasia.

Methods

The study included 44 children with the diagnosis of classic congenital adrenal hyperplasia and 39 healthy children whose age, pubertal status, and gender were similar to those of the patient group. Anthropometric parameters and 17-hydroxyprogesterone levels were measured, and bone age was calculated. The average daily hydrocortisone dose was calculated over the last 1-year file records. Hyperandrogenic state was defined according to bone age SD score (⩾2) and 17-hydroxyprogesterone levels (>10 ng/ml). Echocardiographic examinations were assessed by conventional two-dimensional Doppler echocardiography and tissue Doppler imaging.

Results

Patients had higher morphological parameters, such as left ventricular end-systolic diameter, interventricular septal thickness at end diastole, left ventricular posterior wall thickness at end diastole, left ventricular mass and index, than the control group (p<0.05). On pulsed-wave and tissue Doppler echocardiography, significant subclinical alterations were observed in systolic (isovolumic contraction time), diastolic (isovolumic relaxation time), and global left ventricular functional (myocardial performance index) parameters in the congenital adrenal hyperplasia group compared to the control group (p<0.05). In partial correlation analyses, after controlling the effect of hyperandrogenism, the mean hydrocortisone dosage was positively correlated with isovolumic relaxation time in congenital adrenal hyperplasia group (p<0.05).

Conclusion

This study demonstrated that the patients with congenital adrenal hyperplasia are at risk for left ventricular hypertrophy, systolic and diastolic myocardial subclinical alterations. Overtreatment may be responsible for the increased risk of myocardial dysfunction in patients with congenital adrenal hyperplasia.

Keywords

Myocardial functionchildrencongenital adrenal hyperplasiacorticosteroid therapy
Type
Original Article
Information
Cardiology in the Young , Volume 29 , Issue 3 , March 2019 , pp. 319 - 324
Copyright
© Cambridge University Press 2019 

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Footnotes

Cite this article: Tuhan H, Demircan T, Altıncık A, Çatlı G, Kızılca Ö, Egeli T, Kır M, Can Ş, Dündar B, Böber E, Abacı A. (2019) Impaired systolic and diastolic left ventricular function in children and adolescents with congenital adrenal hyperplasia receiving corticosteroid therapy. Cardiology in the Young29: 319–324. doi: 10.1017/S1047951118002330

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