Early glucocorticoid treatment in congenital adrenal hyperplasia may boost cognitive function
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Children and adolescents with congenital adrenal hyperplasia, or CAH, diagnosed early via a neonatal screening program and treated with hydrocortisone had normal psychometric intelligence and executive function compared with population controls, according to findings published in The Journal of Clinical Endocrinology & Metabolism.
“Good medical treatment with hydrocortisone, a good adherence to therapy and a rapid initiation of treatment facilitated by nationwide neonatal screening may all contribute to the positive effects on cognition,” Valeria Messina, a doctoral student in the department of women’s and children’s health at the Karolinska Institutet in Stockholm, Sweden, told Healio. “Children and adolescents with CAH diagnosed through the Swedish neonatal screening program have normal cognitive abilities. Nevertheless, it cannot be ruled out that episodes of hyponatremia or hypoglycemia can affect cognition later in life.”
In an observational study, Messina and colleagues analyzed data from 32 children with CAH (mean age, 12 years) identified through the Swedish national neonatal screening program for CAH, 11 children with CAH treated prenatally with dexamethasone (mean age, 12 years) and 52 matched population controls (mean age, 11 years). Researchers assessed cognitive abilities with standardized neuropsychological tests (Wechsler scales, Span Board Test, Stroop Interference Test, NEPSY list learning).
Children with CAH who were not prenatally treated performed equally as well as population controls on a series of tests assessing general intellectual ability and executive function. Results persisted in analyses stratified by genotypes.
Children with salt-wasting CAH performed more poorly compared with children with simple-virilizing CAH in a test assessing visuospatial working memory (P = .039); however, the performance was within the normal range for the population.
Girls with CAH treated prenatally with dexamethasone had lower verbal intellectual ability compared with girls with CAH not exposed to prenatal treatment (P = .037).
“Our results suggest that children and adolescents diagnosed through the neonatal screening program for CAH in Sweden have normal cognitive abilities when compared with healthy controls from the general population,” the researchers wrote. “This emphasizes the importance of the neonatal screening program for CAH. Nevertheless, it cannot be ruled out that episodes of hyponatremia or hypoglycemia can affect cognition later in life. Optimal treatment with glucocorticoids (hydrocortisone) appears to be an important and likely explanation for the similar test performance in the children and adolescents with CAH and the controls. Further studies are needed to assess cognition among people with a different treatment regimen and to evaluate the risks and benefits of prenatal dexamethasone treatment.” ” – by Regina Schaffer
For more information:
Valeria Messina can be reached at the Karolinska Institutet, Department of Women's and Children's Health, Pediatric Endocrinology Unit, Karolinska vägen 37A, Karolinska University Hospital, 171 76 Stockholm, Sweden; email: valeria.messina@ki.se.
Disclosures: The authors report no relevant financial disclosures.
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