Lipid profile in congenital adrenal hyperplasia

Glucocorticoids have been reported to exert a marked effect on lipoprotein metabolism. Several studies have shown a potential risk of hyperlipidemia i n patients under long-term glucocorticoid therapy. Current management of pa tients with congenital adrenal hyperplasia (CAH) includes the use of glucoc orticoids to attenuate the increased production of undesirable adrenal horm ones. A case-control study was designed to compare the serum lipid profiles of 14 patients with CAH under glucocorticoid therapy and 14 normal control s and to determine the characteristics of the profiles. A total of 9 patien ts (64.3%) had serum total cholesterol (TC) greater than 4.4 mmol/L (170 mg /dL), compared with 6 individuals in the control group (42.3%). Nine patien ts with CAH (64.3%) had serum triglycerides (TGs) more than 1.0 mmol/L (90 mg/dL), compared with only 2 in the control group (14.3%). Similarly the me an serum TG was higher in the CAH group versus the controls, 1.33 mmol/L (1 18 mg/dL) versus 0.75 mmol/L (67 mg/dL), respectively. Serum low-density li poprotein, (IDL-C) and high-density, lipoprotein (HDL-C) cholesterol were d etermined in 13 children with CAH and in the 14 controls. Nine CAH patients (69.2%) and 8 controls (57%) had LDL-C greater than 2.8 mmol/L (<110 mg/dL ). For HDL-C, 2 children with CAH (15.4%) and 4 controls (28.6%) had levels less than 0.9 mmol/L (35 mg/dL). There were no significant differences for the cholesterol index, 0.24 for the controls and 0.22 for the CAH group. I n the CAH group, the mean serum TG level and the percentage of individuals with TGs greater than 1.0 mmol/L were statistically significant compared wi th the controls. The mean serum TC and LDL-C, as well as the percentage of subjects with levels over the cutoff point, although slightly higher in the CAH group, were of no statistical significance. The results of this pilot study suggest that long-term glucocorticoid therapy in patients with CAH ma y induce abnormalities in the serum lipid profile characterized mainly by a n increment in serum TGs. Copyright (C) 2000 by W.B. Saunders Company.