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Do They Predispose to Atherosclerotic Cardiovascular Disease and Secondary Polycystic Ovary Syndrome?
a Section on Pediatric Endocrinology, Reproductive and Molecular Biology Branch, National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland 20892, USA b First Department of Pediatrics, Athens University Medical School, 11527 Athens, Greece
Key Words: congenital adrenal hyperplasia • obesity • impaired adrenomedullary function • hypercortisolism • endothelial dysfunction • atherosclerotic cardiovascular disease
Address for correspondence: Evangelia Charmandari, 3rd Floor Dorville House, The Middlesex Hospital, Mortimer Street, London, W1T 8AA, United Kingdom. Voice: +44-207-387-9300; fax: +44-207-829-8885. e-mail: charmane{at}mail.nih.gov
Classic congenital adrenal hyperplasia (CAH) due to 21-hydroxylase deficiency is a common autosomal recessive disorder characterized by impaired adrenocortical and adrenomedullary function, and adrenal hyperandrogenism. Compared to normal subjects, patients with classic CAH have increased incidence of obesity and visceral adiposity, hyperinsulinism and insulin resistance, hyperleptinemia, hypertension, and hyperandrogenism. It is likely that the impaired adrenomedullary function and intermittent treatment-related hypercortisolism may account for the above abnormalities, and may predispose these subjects to the development of metabolic syndrome-related endothelial dysfunction and atherosclerotic cardiovascular disease in adulthood. Nonpharmacologic and pharmacologic interventions targeting obesity and/or insulin resistance may offer an improved outcome in terms of cardiovascular morbidity.
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