Increased Liver Enzymes in Adult Women with Congenital Adrenal Hyperplasia Due to 21-Hydroxylase Deficiency

摘要

References(30) Cited-By(8) The aims were assessing liver function tests (LFT) in women with congenital adrenal hyperplasia (CAH) on glucocorticoids. Sixty-one women with genetically verified CAH due to 21-hydroxylase deficiency, aged 18-63 years were compared to 61 controls. Serum alkaline phosphatase (ALP), alanine aminotransferase (ALT ), aspartate aminotransferase (AST) and gamma-glutamyl transpeptidase (GGT), anthropometry and fat mass (dual energy X-ray absorptiometry) were measured. ALT and GGT were higher in the entire patient group (p=0.01and 0.002); AST, GGT and ALP in patients ≥30 years (p=0.007-0.045); all LFT in salt-wasting (p0.001-0.042); GGT in simple virilizing (p=0.008); ALT , GGT and ALP in Null/Null genotype (p=0.018-0.040); ALT and GGT in I2splice genotype (p0.001 and 0.011). Using a recently proposed cut-off level for ALT (0.317 μkat/L), 54% of patients vs 23% of controls had elevated levels (p=0.028). In patients, GGT and ALP correlated with waist circumference and with total body and trunk fat (r=0.274-0.406, p=0.001-0.043). However, ALT, GGT and ALP were increased even in non-obese patients (waist circumference ≤88 cm and body mass index 30 kg/m2) (p=0.012-0.045) mainly attributed to the patients ≥30 years who also demonstrated elevated insulin levels and HOMA-indices. In conclusion, compared with controls, women with CAH have higher LFT, in particular patients ≥30 years and those with severe forms, probably reflecting a higher lifetime glucocorticoid exposure. LFT were positively correlated to measurements of body fat. These women might have increased frequency of NAFLD. The finding of higher LFT also in non-obese patients suggests that not only central obesity but also glucocorticoids per se may influence.