Bacila Irina A, Lawrence Neil R, Alvi Sabah, Cheetham Timothy D, Crowne Elizabeth, Das Urmi, Dattani Mehul T, Davies Justin H, Gevers Evelien, Keevil Brian, Krone Ruth E, Lawrie Allan, Patel Leena, Randell Tabitha, Ryan Fiona J, Ahmed S Faisal, Krone Nils P
Division of Clinical Medicine, School of Medicine and Population Health, University of Sheffield, Western Bank, Sheffield S10 2TH, United Kingdom.
Department of Paediatric Endocrinology, Leeds General Infirmary, Leeds LS1 3EX, United Kingdom.
Eur J Endocrinol. 2025 Aug 29;193(3):329-339. doi: 10.1093/ejendo/lvaf165.
Patients with congenital adrenal hyperplasia (CAH) have increased prevalence of metabolic problems. We studied adiponectin, leptin and resistin in children with CAH, in relation to BMI, treatment, hormonal and metabolic biomarkers.
We analysed 101 patients with 21-hydroxylase deficiency (54 females, 13.0 ± 2.92 years) from 13 centres in the United Kingdom, and 83 sex- and age-matched controls. Blood parameters (leptin, adiponectin, resistin, metabolic and hormonal markers) were measured in fasted state, between 09:00 and 11:00, after the first glucocorticoid (GC) dose.
A difference in adipokines between patients and controls was only found for leptin in males (patients > control, P = .033). In patients and controls, leptin had a positive relationship with BMI-SDS (P < .001). However, adiponectin decreased with the BMI only in patients (P < .001). Contrary to published evidence on the effect of synthetic steroids on leptin, in our cohort, leptin decreased with the increasing first daily hydrocortisone (HC) dose (Log10Leptin = 4.1- 0.08xfirstGCdose (mg/m2), P = .009) but not with the total daily dose. When correcting for BMI, a positive relationship between leptin and insulin was only found in controls (P < .001). Adiponectin decreased with steroid precursor and androgen concentrations (17-hydroxyprogesterone, androstenedione, testosterone, 11-hydroxyandrostenedione, 11-ketotestosterone) in patients.
Our findings indicate a decrease in leptin with the HC dose, consistent with a detrimental effect of glucocorticoid on satiety and hunger pathways in CAH. Adiponectin was decreased in patients with increased androgens concentrations, suggesting it may be used as an indicator of metabolic risk associated with poor hormonal CAH control.
先天性肾上腺皮质增生症（CAH）患者代谢问题的患病率增加。我们研究了CAH患儿的脂联素、瘦素和抵抗素，以及它们与体重指数（BMI）、治疗、激素和代谢生物标志物的关系。
我们分析了来自英国13个中心的101例21-羟化酶缺乏症患者（54例女性，年龄13.0±2.92岁），以及83例性别和年龄匹配的对照。在空腹状态下，于上午9:00至11:00之间，在首次给予糖皮质激素（GC）后测量血液参数（瘦素、脂联素、抵抗素、代谢和激素标志物）。
仅在男性患者中发现瘦素水平与对照组存在差异（患者>对照组，P = 0.033）。在患者和对照组中，瘦素与BMI标准差（BMI-SDS）呈正相关（P < 0.001）。然而，仅在患者中脂联素随BMI降低（P < 0.001）。与合成类固醇对瘦素影响的已发表证据相反，在我们的队列中，瘦素随每日首次氢化可的松（HC）剂量增加而降低（Log10瘦素 = 4.1 - 0.08×首次GC剂量（mg/m2），P = 0.009），但与每日总剂量无关。校正BMI后，仅在对照组中发现瘦素与胰岛素呈正相关（P < 0.001）。在患者中，脂联素随类固醇前体和雄激素浓度（17-羟孕酮、雄烯二酮、睾酮、11-羟雄烯二酮、11-酮睾酮）降低。
我们的研究结果表明瘦素随HC剂量降低，这与糖皮质激素对CAH患者饱腹感和饥饿途径的有害作用一致。雄激素浓度升高的患者脂联素降低，提示它可能用作与CAH激素控制不佳相关的代谢风险指标。
