title: Increased Abdominal Adiposity in Adolescents and Young Adults With Classical Congenital Adrenal Hyperplasia due to 21-Hydroxylase Deficiency.
abstract: BACKGROUND
  Childhood obesity rates in congenital adrenal hyperplasia (CAH) exceed the high rates seen in normal children, potentially increasing their risk of cardiovascular disease (CVD). Abdominal adiposity, in particular visceral adipose tissue (VAT), is strongly associated with metabolic syndrome and CVD. However, it remains unknown whether VAT is increased in CAH.
  
  
  OBJECTIVE
  The objective of the study was to determine whether adolescents and young adults with classical CAH have more VAT and sc adipose tissue (SAT) than matched controls and whether VAT and SAT are associated with biomarkers of metabolic syndrome, inflammation, and hyperandrogenism in CAH.
  
  
  METHODS
  This was a cross-sectional study at a tertiary center.
  
  
  METHODS
  CAH subjects (n = 28; 15.6 ± 3.2 y; 15 females) were matched for age, sex, ethnicity, and body mass index to healthy controls (n = 28; 16.7 ± 2.3 y; 15 females).
  
  
  METHODS
  VAT and SAT, using computed tomography imaging and serum biomarkers associated with CVD risk, were measured. Data are reported as mean ± SD.
  
  
  RESULTS
  Both VAT (43.8 ± 45.5 cm(2)) and SAT (288.1 ± 206.5 cm(2)) were higher in CAH subjects than controls (VAT 26.4 ± 29.6 cm(2) and SAT 226.3 ± 157.5 cm(2); both P < .001). The VAT to SAT ratio was also higher in CAH subjects (0.15 ± 0.07) than controls (0.12 ± 0.06; P < .05). Within CAH, measures of obesity (waist to height ratio, fat mass) and inflammation (plasminogen activator inhibitor-1, high-sensitivity C-reactive protein, leptin) correlated strongly with VAT and SAT. In addition, homeostasis model assessment of insulin resistance, and low-density lipoprotein correlated with abdominal adiposity. There were no sex differences for VAT or SAT in CAH subjects.
  
  
  CONCLUSIONS
  CAH adolescents and young adults have increased abdominal adiposity, with a higher proportion of proinflammatory VAT than SAT. An improved understanding of the mechanism of obesity in CAH may lead to targeted prevention and therapeutics in this high-risk population.
authors.affiliation: Children's Hospital Los Angeles (M.S.K., A.R.-L., A.D.-T., S.D.M., V.G., S.M.S., M.E.G.); Division of Endocrinology (M.S.K., A.R.-L., A.D.-T., S.D.M., M.E.G.) and Hospital Medicine (S.M.S.); and Department of Radiology (V.G.), Los Angeles, California 90027; and The Saban Research Institute and the University of Southern California (M.S.K., S.D.M., V.G., M.E.G.), Los Angeles, California 90027.
authors.forename: Mimi S
authors.initials: MS
authors.lastname: Kim
authors.affiliation: Children's Hospital Los Angeles (M.S.K., A.R.-L., A.D.-T., S.D.M., V.G., S.M.S., M.E.G.); Division of Endocrinology (M.S.K., A.R.-L., A.D.-T., S.D.M., M.E.G.) and Hospital Medicine (S.M.S.); and Department of Radiology (V.G.), Los Angeles, California 90027; and The Saban Research Institute and the University of Southern California (M.S.K., S.D.M., V.G., M.E.G.), Los Angeles, California 90027.
authors.forename: Anna
authors.initials: A
authors.lastname: Ryabets-Lienhard
authors.affiliation: Children's Hospital Los Angeles (M.S.K., A.R.-L., A.D.-T., S.D.M., V.G., S.M.S., M.E.G.); Division of Endocrinology (M.S.K., A.R.-L., A.D.-T., S.D.M., M.E.G.) and Hospital Medicine (S.M.S.); and Department of Radiology (V.G.), Los Angeles, California 90027; and The Saban Research Institute and the University of Southern California (M.S.K., S.D.M., V.G., M.E.G.), Los Angeles, California 90027.
authors.forename: Anh
authors.initials: A
authors.lastname: Dao-Tran
authors.affiliation: Children's Hospital Los Angeles (M.S.K., A.R.-L., A.D.-T., S.D.M., V.G., S.M.S., M.E.G.); Division of Endocrinology (M.S.K., A.R.-L., A.D.-T., S.D.M., M.E.G.) and Hospital Medicine (S.M.S.); and Department of Radiology (V.G.), Los Angeles, California 90027; and The Saban Research Institute and the University of Southern California (M.S.K., S.D.M., V.G., M.E.G.), Los Angeles, California 90027.
authors.forename: Steven D
authors.initials: SD
authors.lastname: Mittelman
authors.affiliation: Children's Hospital Los Angeles (M.S.K., A.R.-L., A.D.-T., S.D.M., V.G., S.M.S., M.E.G.); Division of Endocrinology (M.S.K., A.R.-L., A.D.-T., S.D.M., M.E.G.) and Hospital Medicine (S.M.S.); and Department of Radiology (V.G.), Los Angeles, California 90027; and The Saban Research Institute and the University of Southern California (M.S.K., S.D.M., V.G., M.E.G.), Los Angeles, California 90027.
authors.forename: Vicente
authors.initials: V
authors.lastname: Gilsanz
authors.affiliation: Children's Hospital Los Angeles (M.S.K., A.R.-L., A.D.-T., S.D.M., V.G., S.M.S., M.E.G.); Division of Endocrinology (M.S.K., A.R.-L., A.D.-T., S.D.M., M.E.G.) and Hospital Medicine (S.M.S.); and Department of Radiology (V.G.), Los Angeles, California 90027; and The Saban Research Institute and the University of Southern California (M.S.K., S.D.M., V.G., M.E.G.), Los Angeles, California 90027.
authors.forename: Sheree M
authors.initials: SM
authors.lastname: Schrager
authors.affiliation: Children's Hospital Los Angeles (M.S.K., A.R.-L., A.D.-T., S.D.M., V.G., S.M.S., M.E.G.); Division of Endocrinology (M.S.K., A.R.-L., A.D.-T., S.D.M., M.E.G.) and Hospital Medicine (S.M.S.); and Department of Radiology (V.G.), Los Angeles, California 90027; and The Saban Research Institute and the University of Southern California (M.S.K., S.D.M., V.G., M.E.G.), Los Angeles, California 90027.
authors.forename: Mitchell E
authors.initials: ME
authors.lastname: Geffner
mesh_terms: D050153:Abdominal Fat / Q000000981:diagnostic imaging / Q000473:pathology*; D050154:Adiposity; D000293:Adolescent; D000312:Adrenal Hyperplasia, Congenital / Q000150:complications / Q000453:epidemiology / Q000473:pathology*; D000328:Adult; D002648:Child; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D050152:Intra-Abdominal Fat / Q000000981:diagnostic imaging / Q000473:pathology; D008297:Male; D056128:Obesity, Abdominal / Q000150:complications / Q000453:epidemiology / Q000473:pathology*; D063766:Pediatric Obesity / Q000150:complications / Q000453:epidemiology / Q000473:pathology; D050151:Subcutaneous Fat / Q000000981:diagnostic imaging / Q000473:pathology; D014057:Tomography, X-Ray Computed; D055815:Young Adult