BACKGROUND While the risk for hypoglycemia during acute illness is well described in children with classical congenital adrenal hyperplasia (CAH), there is little evidence for the prevalence of asymptomatic hypoglycemia and the daily glucose patterns in CAH. Herein, we explored the daytime glucose profile of children with classical CAH. METHODS We conducted an observational study in 11 children (6 female; age 3.1 years [1.4, 5.1]; body mass index 17.3 kg/m2 [15.6, 17.9]) with a genetic diagnosis of classical CAH receiving hydrocortisone and fludrocortisone replacement therapy. Participants underwent 2 14-day continuous glucose monitoring (CGM) sessions and an inpatient 24 h series cortisol and adrenocorticotropic hormone (ACTH) measures. Data were analyzed for 3 daytime lags (7 Am-4 Pm, 4 Pm-10pm, 10 Pm-7 Am) corresponding to the hydrocortisone dosing period with cortisol and ACTH measured before the hydrocortisone dose. RESULTS Eleven participants completed at least 1 CGM session, and 7 out of 11 underwent both the CGM session and the cortisol/ACTH serial measures. In the whole cohort, the percentage of time of sensor glucose values <70 mg/dL was higher during the 10 Pm-7 Am and the 7 Am-4 Pm time slots than in the late afternoon period (17% [7, 54] and 15% [6.8, 24] vs 2% [1.1, 16.7] during the periods 7 Am-4 Pm and 4 Pm-10 Pm, respectively [P = .006 and P = .003]). Nighttime hypoglycemia was mostly spent below the 65 mg/dL (10.9% [4.1, 34]). The glycemic pattern paralleled the nadir of daily cortisol at 7 Am (10.3±4.4 μg/dL). A greater percentage of time in hypoglycemia was associated with lower cortisol concentration at 7 Am and 10 Pm (P < .001 and P = .005). CONCLUSIONS Continuous glucose monitoring demonstrated a disrupted daily glucose pattern in children with CAH, paralleled by a lower cortisol concentration. CLINICALTRIALS.GOV REGISTRATION NCT04322435.

中文翻译：

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典型先天性肾上腺增生症儿童的血糖模式：来自连续血糖监测的证据。

背景虽然经典先天性肾上腺增生 (CAH) 儿童急性疾病期间发生低血糖的风险已得到充分描述，但几乎没有证据表明无症状低血糖的患病率以及 CAH 中的每日血糖模式。在此，我们探讨了患有典型 CAH 的儿童的日间血糖曲线。方法 我们对 11 名接受氢化可的松和氟氢可的松替代疗法的遗传诊断为经典 CAH 的儿童（6 名女性；年龄 3.1 岁 [1.4，5.1]；体重指数 17.3 kg/m2 [15.6，17.9]）进行了观察性研究。参与者接受了 2 次为期 14 天的连续血糖监测 (CGM) 课程以及住院 24 小时系列皮质醇和促肾上腺皮质激素 (ACTH) 测量。分析对应于氢化可的松给药期的 3 个日间滞后（上午 7 点至下午 4 点、下午 4 点至上午 10 点、下午 10 点至上午 7 点）的数据，并在氢化可的松给药前测量皮质醇和 ACTH。结果 11 名参与者至少完成了 1 次 CGM 课程，11 名参与者中有 7 人同时接受了 CGM 课程和皮质醇/ACTH 系列测量。在整个队列中，传感器葡萄糖值 <70 mg/dL 的时间百分比在晚上 10 点至上午 7 点和上午 7 点至下午 4 点时段高于下午晚些时候时段 (17% [7, 54]上午 7 点至下午 4 点和下午 4 点至晚上 10 点期间分别为 15% [6.8, 24] 与 2% [1.1, 16.7] [P = .006 和 P = .003]）。夜间低血糖大多发生在 65 mg/dL 以下（10.9% [4.1, 34]）。血糖模式与早上 7 点每日皮质醇的最低点 (10.3±4.4 μg/dL) 平行。上午 7 点和晚上 10 点低血糖时间的比例越高，皮质醇浓度越低（P < .001 和 P = .005）。结论 连续血糖监测显示 CAH 儿童的每日血糖模式被破坏，同时皮质醇浓度较低。临床试验.GOV 注册 NCT04322435。