Longitudinal Assessment of Illnesses, Stress Dosing, and Illness Sequelae in Patients with Congenital Adrenal Hyperplasia

Diala El-Maouche, Courtney J. Hargreaves, Ninet Sinaii, Ashwini Mallappa, Padmasree Veeraraghavan, Deborah P. Merke

Research output: Contribution to journalArticle

5 Citations (Scopus)

Abstract

Context Patients with congenital adrenal hyperplasia (CAH) are at risk for life-threatening adrenal crises. Management of illness episodes aims to prevent adrenal crises. Objective We evaluated rates of illnesses and associated factors in patients with CAH followed prospectively and receiving repeated glucocorticoid stress dosing education. Methods Longitudinal analysis of 156 patients with CAH followed at the National Institutes of Health Clinical Center over 23 years was performed. The rates of illnesses and stress-dose days, emergency room (ER) visits, hospitalizations, and adrenal crises were analyzed in relation to phenotype, age, sex, treatment, and hormonal evaluations. Results A total of 2298 visits were evaluated. Patients were followed for 9.3 ± 6.0 years. During childhood, there were more illness episodes and stress dosing than adulthood (P < 0.001); however, more ER visits and hospitalizations occurred during adulthood (P ≤ 0.03). The most robust predictors of stress dosing were young age, low hydrocortisone and high fludrocortisone dose during childhood, and female sex during adulthood. Gastrointestinal and upper respiratory tract infections (URIs) were the two most common precipitating events for adrenal crises and hospitalizations across all ages. Adrenal crisis with probable hypoglycemia occurred in 11 pediatric patients (ages 1.1 to 11.3 years). Undetectable epinephrine was associated with ER visits during childhood (P = 0.03) and illness episodes during adulthood (P = 0.03). Conclusions Repeated stress-related glucocorticoid dosing teaching is essential, but revised age-appropriate guidelines for the management of infectious illnesses are needed for patients with adrenal insufficiency that aim to reduce adrenal crises and prevent hypoglycemia, particularly in children.

Original languageEnglish (US)
Pages (from-to)2336-2345
Number of pages10
JournalJournal of Clinical Endocrinology and Metabolism
Volume103
Issue number6
DOIs
StatePublished - Jun 1 2018
Externally publishedYes

Fingerprint

Congenital Adrenal Hyperplasia
Emergency rooms
Glucocorticoids
Hospital Emergency Service
Hospitalization
Fludrocortisone
Hypoglycemia
Pediatrics
Epinephrine
Hydrocortisone
Adrenal Insufficiency
Teaching
Education
National Institutes of Health (U.S.)
Health
Respiratory Tract Infections
Guidelines
Phenotype

ASJC Scopus subject areas

  • Endocrinology, Diabetes and Metabolism
  • Biochemistry
  • Endocrinology
  • Clinical Biochemistry
  • Biochemistry, medical

Cite this

Longitudinal Assessment of Illnesses, Stress Dosing, and Illness Sequelae in Patients with Congenital Adrenal Hyperplasia. / El-Maouche, Diala; Hargreaves, Courtney J.; Sinaii, Ninet; Mallappa, Ashwini; Veeraraghavan, Padmasree; Merke, Deborah P.

In: Journal of Clinical Endocrinology and Metabolism, Vol. 103, No. 6, 01.06.2018, p. 2336-2345.

Research output: Contribution to journalArticle

El-Maouche, Diala ; Hargreaves, Courtney J. ; Sinaii, Ninet ; Mallappa, Ashwini ; Veeraraghavan, Padmasree ; Merke, Deborah P. / Longitudinal Assessment of Illnesses, Stress Dosing, and Illness Sequelae in Patients with Congenital Adrenal Hyperplasia. In: Journal of Clinical Endocrinology and Metabolism. 2018 ; Vol. 103, No. 6. pp. 2336-2345.
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N2 - Context Patients with congenital adrenal hyperplasia (CAH) are at risk for life-threatening adrenal crises. Management of illness episodes aims to prevent adrenal crises. Objective We evaluated rates of illnesses and associated factors in patients with CAH followed prospectively and receiving repeated glucocorticoid stress dosing education. Methods Longitudinal analysis of 156 patients with CAH followed at the National Institutes of Health Clinical Center over 23 years was performed. The rates of illnesses and stress-dose days, emergency room (ER) visits, hospitalizations, and adrenal crises were analyzed in relation to phenotype, age, sex, treatment, and hormonal evaluations. Results A total of 2298 visits were evaluated. Patients were followed for 9.3 ± 6.0 years. During childhood, there were more illness episodes and stress dosing than adulthood (P < 0.001); however, more ER visits and hospitalizations occurred during adulthood (P ≤ 0.03). The most robust predictors of stress dosing were young age, low hydrocortisone and high fludrocortisone dose during childhood, and female sex during adulthood. Gastrointestinal and upper respiratory tract infections (URIs) were the two most common precipitating events for adrenal crises and hospitalizations across all ages. Adrenal crisis with probable hypoglycemia occurred in 11 pediatric patients (ages 1.1 to 11.3 years). Undetectable epinephrine was associated with ER visits during childhood (P = 0.03) and illness episodes during adulthood (P = 0.03). Conclusions Repeated stress-related glucocorticoid dosing teaching is essential, but revised age-appropriate guidelines for the management of infectious illnesses are needed for patients with adrenal insufficiency that aim to reduce adrenal crises and prevent hypoglycemia, particularly in children.

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