Multicenter Analysis of Cardiometabolic-Related Diagnoses in Youth With Congenital Adrenal Hyperplasia: A PEDSnet Study

Context: Small cohorts of youth with congenital adrenal hyperplasia (CAH) demonstrate increased risk of obesity and poor cardiometabolic health. Objective: To determine the odds of cardiometabolic-related diagnoses in youth with CAH compared with matched controls in a cross-sectional analysis in a large, multisite database (PEDSnet). Methods: Electronic health record data (2009-2019) from 6 PEDSnet sites were used to determine odds of cardiometabolic-related outcomes based on diagnosis, anthropometric, and laboratory data using logistic regression among youth with CAH vs controls. Youth with CAH and ≥1 outpatient visit in PEDSnet (n = 1647) were propensity score–matched on 8 variables to controls (n = 6588). A subset of youth with classic CAH (n = 547, with glucocorticoid and mineralocorticoid prescriptions) were matched to controls (n = 2188). Odds of having cardiometabolic-related diagnoses among youth over 2 years with CAH were compared with matched controls. Results: Outcomes were calculated for all individuals with CAH (median age at last visit 12.9 years [7.3, 17.6]) and a subset with classic CAH (median age at last visit 11.6 years [4.7, 17.5]) compared with their matched controls. All individuals with CAH had higher odds of overweight/ obesity (odds ratio [95% CI] 3.63 [3.24,4.07]), hypertension (3.07 [2.60,3.64]), dysglycemia (1.95 [1.35,2.82], dyslipidemia (2.28 [1.79,2.91]), and liver dysfunction (2.30 [1.91,2.76]) than matched controls. Individuals with classic CAH had higher odds of overweight/obesity (3.21 [2.61,3.93]), hypertension (8.22 [6.71,10.08]), and liver dysfunction (2.11 [1.55,2.89]) than matched controls. Conclusion: Overall, youth with CAH are at increased risk of diagnoses related to worse cardiometabolic health.