J Clin Res Pediatr Endocrinol. Ahead of Print: JCRPE-87699 | DOI: 10.4274/jcrpe.galenos.2023.2023-3-5

Continuous Glucose Monitoring in Children and Adolescents with Congenital Adrenal Hyperplasia

Ilja Dubinski¹, Susanne Bechtold-Dalla Pozza¹, Belana Debor¹, Hannah Franziska Nowotny², Nicole Reisch², Lea Tschaidse², Heinrich Schmidt^1
1Department of Paediatrics, Division of Paediatric Endocrinology, Dr. von Hauner Children's Hospital, University Hospital, LMU Munich
²Department of Medicine IV, University Hospital, LMU Munich

INTRODUCTION: Patients with congenital adrenal hyperplasia require lifelong therapy with glucocorticoids to suppress androgen excess and substitute for deficient cortisol. An important aspect of care is the prevention of metabolic sequelae. In infants, potentially lethal nocturnal hypoglycaemia has been described. In adolescence, visceral obesity, hypertension, hyperinsulinism and insulin resistance come into focus. To date, systematic studies of glucose profiles are lacking.
METHODS: We conducted a monocentric prospective observational study to determine the glucose profiles under different treatment regimens. We used the latest generation FreeStyle Libre 3® sensor in blinded mode as a device for CGM. Furthermore, therapeutic/ auxological data were obtained.
RESULTS: Our cohort of 10 children/ adolescents had a mean age of 11 years. Three patients showed morning fasting hyperglycaemia. Overall, 6 out of 10 patients had too little total values in the desired range of 70-120 mg/dl. Tissue glucose values above 140-180 mg/dl were found in 5 of 10 patients. All patients had an average value for glycosylated haemoglobin of 5.8 %. All pubertal adolescents with reverse circadian regimens had significantly higher glucose levels at night. Two adolescents showed asymptomatic nocturnal hypoglycaemia.
DISCUSSION AND CONCLUSION: A high number of subjects showed abnormalities in glucose metabolism. Two-thirds had elevated total 24h glucose values outside the age-appropriate reference values. Thus, this aspect may need to be addressed early in life by adjusting the doses, treatment regimen or dietary measures. Consequently, reverse circadian therapy regimens should be critically indicated and closely monitored due to the potential metabolic risk.

Keywords: Congenital adrenal hyperplasia, continuous glucose monitoring, hypoglycaemia, hydrocortisone

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