{"doi":"10.1210/clinem/dgab133","title":"Cardiovascular Disease Risk Factors and Metabolic Morbidity in a Longitudinal Study of Congenital Adrenal Hyperplasia","abstract":"CONTEXT: Patients with congenital adrenal hyperplasia (CAH) are exposed to hyperandrogenism and supraphysiologic glucocorticoids, both of which can increase risk of metabolic morbidity. OBJECTIVE: Our aim was to evaluate cardiovascular and metabolic morbidity risk in a longitudinal study of patients with CAH spanning both childhood and adulthood. DESIGN AND SETTING: Patients with classic CAH followed for a minimum of 5 years during both childhood and adulthood (n = 57) at the National Institutes of Health were included and compared with the US general population using NHANES data. MAIN OUTCOME MEASURES: Obesity, hypertension, insulin resistance, fasting hyperglycemia, and dyslipidemia. RESULTS: Compared to the US population, patients with CAH had higher (P < 0.001) prevalence of obesity, hypertension, insulin resistance, fasting hyperglycemia, and low high-density lipoprotein (HDL) during childhood and obesity (P = 0.024), hypertension (P<0.001), and insulin resistance (P < 0.001) during adulthood. In our cohort, obesity, hypertension, fasting hyperglycemia, and hypertriglyceridemia began prior to age 10. During childhood, increased mineralocorticoid dose was associated with hypertension (P = 0.0015) and low HDL (P = 0.0021). During adulthood, suppressed androstenedione was associated with hypertension (P = 0.002), and high low-density lipoprotein (P = 0.0039) whereas suppressed testosterone (P = 0.003) was associated with insulin resistance. Elevated 17-hydroxyprogesterone, possibly reflecting poor disease control, was protective against high cholesterol (P = 0.0049) in children. Children whose mothers were obese (maternal obesity) had increased risk of obesity during adulthood (P = 0.0021). Obesity, in turn, contributed to the development of hypertension, insulin resistance, and hypertriglyceridemia in adulthood. CONCLUSION: Patients with CAH develop metabolic morbidity at a young age associated with treatment-related and familial factors. Judicious use of glucocorticoid and mineralocorticoid is warranted.","journal":"The Journal of Clinical Endocrinology & Metabolism","year":2021,"id":154030,"datarank":2.447629210682463,"base_score":4.189654742026425,"endowment":4.189654742026425,"self_citation_contribution":0.6284482113039639,"citation_network_contribution":1.819180999378499,"self_endowment_contribution":0.6284482113039639,"citer_contribution":1.819180999378499,"corpus_percentile":null,"corpus_rank":null,"citation_count":65,"citer_count":59,"citers_with_citation_signal":50,"citers_with_endowment":50,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.8793,"is_data_producer":true,"deposit_databanks":{"ClinicalTrials.gov":["NCT00250159"]},"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2021-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":321283,"name":"Ninet Sinaii","orcid":"0000-0003-4045-1386","position":1,"is_corresponding":false},{"id":331658,"name":"Smita Jha","orcid":"0000-0001-9201-3340","position":2,"is_corresponding":false},{"id":653130,"name":"Jay Desai","orcid":"0009-0008-5526-1466","position":3,"is_corresponding":false},{"id":483425,"name":"Diala El‐Maouche","orcid":"0000-0002-0936-2249","position":4,"is_corresponding":false},{"id":414564,"name":"Ashwini Mallappa","orcid":"0000-0003-0637-4559","position":5,"is_corresponding":false},{"id":404052,"name":"Deborah P. Merke","orcid":"0000-0002-3746-0460","position":6,"is_corresponding":false},{"id":653129,"name":"Ahmed Torky","orcid":"0000-0001-8036-5779","position":0,"is_corresponding":true}],"reference_count":44,"raw_metadata":null,"created_at":"2026-07-18T23:43:49.684414Z","pmid":"33677504","pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}