Visceral adiposity index and metabolic profile in adult patients with congenital adrenal hyperplasia: hydrocortisone versus prednisone treatment.

Background: Patients with Congenital Adrenal Hypeplasia (CAH) due to 21-hydroxylase deficiency need a life-long therapy with glucocorticoids (GCs) and tend to have a cluster of metabolic risk factors, which are consistent with metabolic syndrome (MS). Most frequently used GCs are Hydrocortisone (HC) and Prednisone (P), different for both pharmacodynamic and pharmacokynetic characteristics. Aim: The aim of this study was to evaluate the impact of HC and P on VAI, a new indicator of visceral fat function, and on metabolic profile in CAH patients long term treated with GC. Materials and Methods: Thirty-two patients (22 F, 10 M, 18-46 yrs), among which 16 (11 F, 5 M) treated with HC (dose 10-45 mg/die) and 16 (11 F, 5 M) treated with P (dose 5-15 mg/die), were retrospectively enrolled in the study. VAI was calculated according to Amato and colleagues. Metabolic profile was evaluated measuring each component of MS, in line with IDF criteria, as well as the area under the curve (AUC) of glucose and insulin during 120 min oral glucose tolerance test (OGTT), the homeostasis model assessment of the insulin resistance index (HOMA-IR) and the insulin sensitivity index (ISI). Results: Patients treated with P showed higher VAI (p< 0.001), waist circumference (p=0,03), triglycerides (P<0,001), fasting insulin (p= 0,047), AUC for insulin (p=0,001), HOMA-IR (p=0,038) and lower ISI (p=0,038) than patients treated with HC, whereas no significant difference was found in total cholesterol, LDL- and HDL-cholesterol, blood pressure, fasting glucose and AUC for glucose as well as in the prevalence of MS. Conclusion: The results of the current study demonstrated that among CAH patients, longterm treatment with P is strongly associated with an higher visceral adiposity dysfunction and insulin resistance compared to treatment with HC.