ISSN: 1308-5727 | E-ISSN: 1308-5735
Volume : 15 Issue : 4 Year : 2023
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Turkish Society for Pediatric Endocrinology and Diabetes
Continuous Glucose Monitoring in Children and Adolescents with Congenital Adrenal Hyperplasia [J Clin Res Pediatr Endocrinol]
J Clin Res Pediatr Endocrinol. 2023; 15(4): 380-389 | 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, Hanna Franziska Nowotny2, Nicole Reisch2, Lea Tschaidse2, Heinrich Schmidt1
1Dr. von Hauner Children’s Hospital; Ludwig Maximilian University, Department of Paediatrics, Division of Paediatric Endocrinology, Munich, Germany
2Ludwig Maximilian University, Department of Medicine IV, Munich, Germany

INTRODUCTION: Patients with congenital adrenal hyperplasia (CAH) 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 are reported. To date, systematic studies of glucose profiles in this age group with CAH are lacking.
METHODS: This was a monocentric, prospective, observational study to determine the glucose profiles under different treatment regimens in a cohort of young patients with CAH. The continuous glucose monitoring device used was the latest generation FreeStyle Libre 3® sensor in blinded mode. Therapeutic and auxological data were obtained.
RESULTS: The cohort consisted of 10 children/adolescents with a mean age of 11 years. Three patients exhibited morning fasting hyperglycaemia. Overall, 6 out of 10 patients had unacceptably few 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. The mean value for glycosylated haemoglobin for the cohort was 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: Most of the patients exhibited 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

Ilja Dubinski, Susanne Bechtold-Dalla Pozza, Belana Debor, Hanna Franziska Nowotny, Nicole Reisch, Lea Tschaidse, Heinrich Schmidt. Continuous Glucose Monitoring in Children and Adolescents with Congenital Adrenal Hyperplasia. J Clin Res Pediatr Endocrinol. 2023; 15(4): 380-389

Corresponding Author: Ilja Dubinski, Germany
Manuscript Language: English
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