Adrenomedullin level in children with congenital adrenal hyperplasia: Relationship to vascular and left ventricular functions

Abstract

Purpose: To evaluate left venticular, vascular endothelial function and its association with adrenomedullin (AM) levels in children with classic CAH. Methods: 42 children with classic CAH (mean age of 13.5±2.4 years) were compared to 42 healthy controls. Measurement of 17-hydroxy-progesterone, total testosterone, and AM levels were carried out. LV functions and cardiac dimensions were measured with traditional echocardiography. Brachial artery flow-mediated dilation (FMD%) and carotid intima-media thickness (CA-IMT) were measured via vascular ultrasonography. According to the control on medical treatment, patients were classified into poor (n = 12) and good (n = 30) controlled groups. Results: Patients had significant higher AM levels and LVM index (LVMI), while lower brachial FMD%, a thicker CA-IMT, and a prolonged mitral deceleration time (DcT) in relation to controls. These changes were marked in children with poorly controlled on medical treatment. In multivariate analysis, AM levels were significantly correlated with systolic (OR =; 95% ) and diastolic blood pressures (OR = 2.9; 95% ), Testosterone ( OR =3.46; 95% CI = 1.55-2.13, ), LVMI (OR = 2.6; 95% CI: 1.1– 1.13), mitral DcT (OR = 2.4; 95% CI: 1.15–2.05; ), CA-IMT (OR = 1.6; 95% CI: 1.16–1.57) ,and FMD% (OR =2.6; 95%CI = 1.33-2.89) . Conclusions: AM level was elevated in children with classic CAH, especially in those not well controlled on medical treatment, and it was correlated with LVMI, mitral DcT, CA-IMT, and FMD%. Children with CAH who are at increased risk of developing subclinical CV problems may benefit from measuring AM level.