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Altered 24-Hour Blood Pressure Profiles in Children and Adolescents with Classical Congenital Adrenal Hyperplasia due to 21-Hydroxylase Deficiency

Divisions of Pediatric Endocrinology (T.M.K.V., D.S., H.G.D.) and Nephrology (J.D., W.R.), Department of Pediatrics and Adolescent Medicine, Friedrich-Alexander-University of Erlangen-Nuremberg, 91054 Erlangen, Germany

Address all correspondence and requests for reprints to: Professor Helmuth G. Dörr, M.D., Department of Pediatrics and Adolescent Medicine, Friedrich-Alexander-University of Erlangen-Nuremberg, Loschgestrasse 15, 91054 Erlangen, Germany. E-mail: hgdoerr{at}kinder.imed.uni-erlangen.de.

Objective: Children and adolescents with classical congenital adrenal hyperplasia have been shown to be at risk for obesity associated with higher insulin and leptin levels. Because these factors are also known to cause hypertension, the aim of this study was to analyze 24-h blood pressure profiles and their relation to different clinical and laboratory parameters.

Design: Fifty-five subjects, aged between 5.3 and 19.0 yr, were enrolled in a prospective, cross-sectional study. All patients had genetically proven 21-hydroxylase deficiency and underwent ambulatory 24-h blood pressure monitoring during a period off school/work.

Results (Median, Range): The median body mass index of the cohort was significantly elevated [1.09 SD score (SDS), –2.45 to 3.77]. Daytime and nighttime systolic blood pressures were also significantly elevated (0.67 SDS, –1.5–4.1; 0.63 SDS, –0.91 to 3.3), whereas daytime diastolic blood pressure was significantly lowered (–0.81 SDS, –2.6 to 3.2) and normal during the night (0.11 SDS, –2.0 to 2.0). Overall, there was a normal nocturnal drop of systolic (12.8%, 2.1–22.8) but not diastolic blood pressure (17.2%, 0.90–25.8). The different parameters of systolic and diastolic blood pressures were significantly correlated with body mass index and skinfold thickness (r_s = 0.271–0.486). There was no correlation with equivalent hydrocortisone and fludrocortisone dosage and laboratory parameters except for serum leptin and insulin.

Conclusions: Our data show altered 24-h blood pressure profiles with elevated systolic levels correlated with the degree of overweight and obesity, whereas normal-weight patients tended to diastolic hypotension.