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Adrenal (Excluding Mineralocorticoids)

SAT-461 - Longitudinal Assessment of Cardiometabolic Risk Factors in Adults with Classic Congenital Adrenal Hyperplasia: Influence of Hormonal Control

Saturday, June 13, 2026
9:30 AM - 4:30 PM CT
Location: ENDOExpo; Poster Floor
Disclosure(s):
Ana Carolina Oliveira, MD.: No financial relationships to disclose
Jessica Me Lin Ie, MD: No financial relationships to disclose
Context: Adults with the classic forms of congenital adrenal hyperplasia (CAH) may be predisposed to cardiometabolic complications due to lifelong glucocorticoid (GC) exposure and/or periods of androgen excess. However, longitudinal data extending into adulthood, particularly those addressing the impact of hormonal control on metabolic outcomes, remain limited.

Objective: To evaluate long-term changes in cardiometabolic risk factors in adults with the classic forms of CAH from the transition period to adulthood, according to hormonal control status.

Methods: A longitudinal observational study was conducted at a single tertiary referral center and included fifty-nine adults with the classic forms of CAH, followed from late adolescence (mean age 18.6 ± 1.5 years at the beginning of follow-up) over a mean period of 14.8 ± 9.2 years. The evaluation of these patients generated a total of 2,783 data points for analysis. Hormonal control was classified based on serum androstenedione and 17-hydroxyprogesterone levels. Long-term changes in BMI, fasting blood glucose, HOMA-IR, and serum LDL-c, HDL-c, and triglyceride levels were analyzed using linear mixed-effects models.

Results: Participants were treated with relatively low GC doses, which declined from 11.2 ± 8.1 to approximately 6–7 mg/m²/day, expressed as hydrocortisone equivalents, over follow-up. BMI was elevated at baseline (25.4 ± 5.0 kg/m²) and remained stable thereafter. Mean fasting blood glucose and lipid parameters remained within the normal ranges. BMI and age were the main predictors of higher LDL-c and triglyceride levels, whereas higher BMI and androstenedione levels were associated with lower HDL-c. BMI was the main determinant of HOMA-IR, which decreased from 3.52 ± 2.95 at the transition period to lower values at later assessments. Higher BMI was associated with lower mean GC doses, consistent with clinical dose-adjustment practices.

Conclusions: In adults with the classic forms of CAH treated with relatively low GC doses, cardiometabolic parameters remained stable across follow-up. Notably, many individuals already entered adulthood with overweight or obesity. Adiposity and age, rather than GC exposure or hormonal control, were the main determinants of metabolic variability, highlighting the importance of early weight-management strategies in this population.

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