Frequency of stress dosing and adrenal crisis in paediatric and adult patients with congenital adrenal hyperplasia: A prospective study

Abstract

Objective: Patients with congenital adrenal hyperplasia (CAH) require life-long glucocorticoid replacement, including stress dosing (SD). This study prospectively assessed adrenal crisis (AC) incidence, frequency, and details of SD and disease knowledge in adult and paediatric patients and their parents. Design: Prospective, observational study. Methods: Data on AC and SD were collected via a patient diary. In case of AC, medical records were reviewed and patient interviews conducted. Adherence to sick day rules of the German Society of Endocrinology (DGE) and disease knowledge using the German version of the CAH knowledge assessment questionnaire (CAHKAQ) were assessed. Results: In 187 adult patients, the AC incidence was 8.4 per 100 patient years (py) and 5.1 in 100py in 38 children. In adults, 195.4 SD episodes per 100py were recorded, in children 169.7 per 100py. In children 72.3% and in adults 34.8%, SD was performed according to the recommendations. Children scored higher on the CAHKAQ than adults (18.0 [1.0] vs 16.0 [4.0]; P =. 001). In adults, there was a positive correlation of the frequency of SD and the incidence of AC (r =. 235, P =. 011) and CAHKAQ score (r =. 233, P =. 014), and between the incidence of AC and CAHKAQ (r =. 193, P =. 026). Conclusion: The AC incidence and frequency of SD in children and adults with CAH are high. In contrast to the paediatric cohort, the majority of SD in adults was not in accordance with the DGE recommendations, underlining the need for structured and repeated education of patients with particular focus on transition.