Blair, Joanne

Hawcutt, Daniel

Lip, Gregory

Park, Julie

Shantsila, Helen

University of Liverpool Repository

59ESPEPresentedat:Increased risk of cardiovascular disease and increased subclinical atherosclerosis have been reported in CYP with PAI when compared to healthy children. Carotid intima media thickness (CIMT) can be used as an early marker of cardiovascular disease. The severity of adverse metabolic profile has been related to the total hydrocortisone dose and duration of treatment.To assess the prevalence of increased CIMT, an early marker of cardiovascular risk, in children with PAI. Children with primary AI treated with hydrocortisone (HC) attended the CRF. Demographics were recorded, as was height, weight and blood pressure. Measurements for CIMT were taken approximately 0.5cm distal from the carotid bulb on the right carotid artery. Average measurements were taken of these images.Two sitting blood pressure measurements were taken from the left arm and an average was ascertained.Children > 10 years also had 24-hour ambulatory blood pressure recorded when tolerated. These preliminary data show CIMT measurements that are in the normal range, in this cohort of CYP with PAI.Hypertension is evident within this population.Contrary to historical data, early subclinical atherosclerotic changes have not been identified. This may reflect good clinical practice. Hydrocortisone doses are reviewed and adjust regularly, guided by both clinical and biochemical parameters.  (Dalla Pozza, Ehringer-Schetitska et al. 2015)Dr Julie Park Julie.park@alderhey.nhs.ukProfessor Jo Blair jo.blair@alderhey.nhs.uk17 Children (aged 9.9 ± 4.1 years) participated in the cardiovascular aspect of the study. 3 children had Addison’s, 14 had congenital adrenal hyperplasia (9 of whom had salt wasting).2 children could not tolerate ultrasonography.Table 1. Patient characteristics of children with PAI who had CIMT performed.7 children showed evidence of hypertension on sitting blood pressure (>95th centile)4 children showed evidence of diastolic BP >95th centile.Children with BP readings >95th centile were on HC doses 5.6-10.8mg/m2/day and fludrocortisone doses 0-175 mcg/day.Doses were reviewed and adjusted in those with hypertension. These measurements will be repeated at their next clinic appointment. One child has hypertension of unknown cause who is currently being investigated.J. Park1,3, D. B. Hawcutt1,3, A. Shantsila2,3, G. Lip2,3, J. Blair1,31. Alder Hey Children’s Hospital, Liverpool, UK2. Liverpool Centre for Cardiovascular Science, Liverpool Heart and Chest Hospital, UK3. University of Liverpool, Liverpool, UKCARDIOVASCULAR RISK IN CHILDREN WITH PRIMARY ADRENAL INSUFFICIENCY (PAI) : PRELIMINARY DATAMy supervisors (co-authors) for supervising my MDSinead Stewart and all of the  nurses on the Clinical Research Facility at Alder Hey Children’s Hospital who made this study possiblePauline Blundell, endocrine nurse specialist for providing supportDr Senniappan and Dr Das for contributing patients and ongoing supportINTRODUCTIONAIMMETHODCONCLUSIONS ACKNOWLEDGEMENTSREFERENCESCONTACT INFORMATIONRESULTSParameter (n = 17) Mean ± SDHeight SDS 0·81 ± 1·34BMI SDS 0·13 ± 1·21Height SDS 0·81 ± 1·34BMI SDS 0·13 ± 1·21Length of time since diagnosis (years)6·06 ± 4·05Hydrocortisone dose (mg/m2/day)10·8 ± 3·93Blood pressure measurementsSystolic blood pressure centile (percentile)75·6 ± 34·2Diastolic blood pressure centile (percentile)59·0 ± 25·3Table 2. Average sitting blood pressure in children with PAI treated with hydrocortisonePhotograph highlighting correct assessment of CIMT1Median, IQRCIMT measurement (mm) 0·41 (0·40-0·48)CIMT measurements were within normal limits when compared to that of healthy children.1Linear regression analysis, adjusted for age, length of time since diagnosis/start of hydrocortisone treatment and dose of hydrocortisone taken did not show an association with CIMT values. Table 3. Carotid intima media measurements in children with primary adrenal insufficiencyP2-035Julie ParkAdrenals and HPA Axis

Assessment of blood pressure and carotid intima media thickness (CIMT) in children with primary adrenal insufficiency

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Assessment of blood pressure and carotid intima media thickness (CIMT) in children with primary adrenal insufficiency

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