title: Glucocorticoid treatment regimen and health outcomes in adults with congenital adrenal hyperplasia.
abstract: BACKGROUND
  Adults with congenital adrenal hyperplasia (CAH) are treated with a wide variety of glucocorticoid treatment regimens.
  
  
  OBJECTIVE
  To test whether drug dose and timing of glucocorticoid treatment regimen impacts on health outcomes. This was a cross-sectional study of 196 adult CAH patients in whom treatment and health outcomes were measured. Glucocorticoid dose was converted to prednisolone dose equivalent (PreDEq) using three published formulae. Associations between the type of glucocorticoid regimen and PreDEq with specific health outcome variables were tested using partial correlation and principal components analysis (PCA).
  
  
  RESULTS
  Patients on dexamethasone had lower androgens and ACTH but greater insulin resistance compared with those receiving hydrocortisone or prednisolone. Dexamethasone dose and once daily administration were associated with insulin resistance. Partial correlation analysis adjusted for age and sex showed PreDEq weakly correlated (r < 0·2) with blood pressure and androstenedione. Mutation severity was associated with increased PreDEq (F(3,141)  = 4·4, P < 0·01). In PCA, 3 PCs were identified that explained 62% of the total variance (r(2) ) in observed variables. Regression analysis (age and sex adjusted) confirmed that PC2, reflecting disease control (androstenedione, 17-hydroxypregesterone and testosterone), and PC3, reflecting blood pressure and mutations (systolic and diastolic blood pressure and mutation severity), related directly to PreDEq (r(2)  = 23%, P < 0·001).
  
  
  CONCLUSIONS
  In adults with congenital adrenal hyperplasia, dexamethasone use was associated with lower androgens but greater insulin resistance, and increasing glucocorticoid dose associated with increased blood pressure, poor disease control and mutation severity.
authors.affiliation: Department of Endocrinology, University College London Hospitals, London, UK.
authors.forename: T S
authors.initials: TS
authors.lastname: Han
authors.forename: R H
authors.initials: RH
authors.lastname: Stimson
authors.forename: D A
authors.initials: DA
authors.lastname: Rees
authors.forename: N
authors.initials: N
authors.lastname: Krone
authors.forename: D S
authors.initials: DS
authors.lastname: Willis
authors.forename: G S
authors.initials: GS
authors.lastname: Conway
authors.forename: W
authors.initials: W
authors.lastname: Arlt
authors.forename: B R
authors.initials: BR
authors.lastname: Walker
authors.forename: R J
authors.initials: RJ
authors.lastname: Ross
mesh_terms: D000312:Adrenal Hyperplasia, Congenital / Q000188:drug therapy*; D000328:Adult; D003430:Cross-Sectional Studies; D003907:Dexamethasone / Q000008:administration & dosage / Q000627:therapeutic use*; D004359:Drug Therapy, Combination; D004734:Energy Metabolism / Q000187:drug effects; D005260:Female; D006801:Humans; D006854:Hydrocortisone / Q000008:administration & dosage / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D055815:Young Adult
chemical_list: D003907:Dexamethasone; D006854:Hydrocortisone