The Journal of Clinical Endocrinology and Metabolism Journal Article

Cognition in Children and Adolescents With CAH

January 12, 2020
 

Valeria Messina, Leif Karlsson, Tatja Hirvikoski, Anna Nordenström, Svetlana Lajic
The Journal of Clinical Endocrinology & Metabolism, Volume 105, Issue 3, March 2020, dgaa016
https://doi.org/10.1210/clinem/dgaa016

Abstract

Context

Patients with classic congenital adrenal hyperplasia (CAH) are treated postnatally with lifelong glucocorticoid (GC) replacement therapy. Previous results on general cognitive ability in individuals with CAH have been conflicting.

Objective

To evaluate long-term cognitive effects of GC replacement therapy and the impact of early diagnosis in children with CAH.

Design and Setting

Observational study with patients from a single research institute.

Patients

32 children with CAH (mean age 11.5 years) identified through the Swedish national neonatal screening program for CAH and 52 matched population controls (mean age 10.7 years). Eleven (6 female) children with CAH who were treated prenatally with dexamethasone (DEX), (CAH-DEX) (mean age 11.7 years).

Intervention

GC replacement therapy, neonatal screening for CAH.

Measures

Cognitive abilities assessed with standardized neuropsychological tests (Wechsler scales, Span Board Test, Stroop Interference Test, NEPSY list learning).

Results

Children with CAH (not prenatally treated) performed equally well as population controls on a series of tests assessing general intellectual ability and executive functions. No significant differences were observed in cognitive performance between patients with different genotypes (null, non-null). Patients with salt-wasting CAH performed poorer than patients with simple virilizing CAH in a test assessing visuo-spatial working memory (P = 0.039), although the performance was within the normal range for the population. Prenatally DEX-treated girls with CAH had lower verbal intellectual ability compared with CAH girls not exposed to prenatal treatment (P = 0.037).

Conclusion

Children and adolescents with CAH who were diagnosed early via a neonatal screening program and treated with hydrocortisone had normal psychometric intelligence and executive functions.

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