Blood pressure, fludrocortisone dose and plasma renin activity in children with classic congenital adrenal hyperplasia due to 21‐hydroxylase deficiency followed from birth to 4 years of age. (17th June 2014)

• Record Type: Journal Article
• Authors: Bonfig, Walter; Schwarz, Hans Peter
• Is Part Of: Clinical endocrinology. Volume 81:Number 6(2014:Dec.)
• Page Start: 871
• Page End: 875
• Publication Date: 2014-06-17
• Subjects: Endocrinology -- Periodicals; 616.4005
• DOI: 10.1111/cen.12498
• Languages: English
• ISSNs: 0300-0664

Abstract

<abstract abstract-type="main" id="cen12498-abs-0001"> <title>Summary</title> <sec id="cen12498-sec-0001" sec-type="section"> <title>Introduction</title> <p>Infants with congenital adrenal hyperplasia (CAH) require higher doses of fludrocortisone (FC) due to physiological mineralocorticoid resistance. The adequacy of mineralocorticoid replacement should be closely monitored to avoid hypertension.</p> </sec> <sec id="cen12498-sec-0002" sec-type="section"> <title>Objective</title> <p>To evaluate blood pressure (BP) in infants with CAH due to 21‐hydroxylase deficiency.</p> </sec> <sec id="cen12498-sec-0003" sec-type="section"> <title>Patients and Methods</title> <p>Thirty‐three patients (18f/15 m) diagnosed by newborn screening were followed until the age of 4 years. Mean start of HC and FC treatment was day 9·8 ± 9·2 postnatally. Mean daily HC dose ranged from 8·6 to 12·3 mg/m<sup>2</sup>/day.</p> </sec> <sec id="cen12498-sec-0004" sec-type="section"> <title>Results</title> <p>During the first year of life prevalence of systolic hypertension was up to 45·5%. At 12 and at 18 months, BP was highest. Prevalence of systolic hypertension was up to 57·6% at 18 months of age. After 24 months BP levels were lower and at 48 months prevalence of hypertension decreased to 15·2%. Systolic and diastolic BP correlated significantly with the administered fludrocortisone dose (<italic>r</italic> = 0·3, <italic>P</italic> = 0·005), but not with body mass index. Hypertensive children received significantly higher FC doses and had significantly lower plasma renin activity during the study period.</p> </sec> <sec id="cen12498-sec-0005" sec-type="section"> <title>Conclusion</title> <p>High prevalence of transient, most likely FC induced hypertension was found in young children with classic CAH diagnosed by newborn screening. The changing mineralocorticoid sensitivity in infants is a risk factor for the development of hypertension in patients with CAH, who are treated with FC. Therefore suppressed plasma renin activity should be avoided to prevent arterial hypertension.</p> </sec> </abstract>