Salivary 17-hydroxyprogesterone (17-OHP) and androstenedione in monitoring efficacy of treatment among Indonesian Congenital Adrenal Hyperplasia Patients

Authors

  • Achmad Zulfa Juniarto Department of Human Genetics, Center for Biomedical Research Faculty of Medicine, Diponegoro University, Semarang, Indonesia
  • Gerard Noppe Department of Pediatrics, Division of Endocrinology ,Erasmus University MC-Sophia Rotterdam, the Netherlands
  • Nani Maharani Department of Human Genetics, Center for Biomedical Research Faculty of Medicine, Diponegoro University, Semarang, Indonesia
  • Erica van den Akker Department of Pediatrics, Division of Endocrinology ,Erasmus University MC-Sophia Rotterdam, the Netherlands
  • Rudy Susanto Department of Pediatrics, Division of Endocrinology, Faculty of Medicine Diponegoro University, Semarang, Indonesia
  • Sultana MH Faradz Department of Human Genetics, Center for Biomedical Research Faculty of Medicine, Diponegoro University, Semarang, Indonesia
  • Frank H. de Jong Department of Internal Medicine, Section of Endocrinology, Erasmus University Medical Center, Rotterdam, the Netherlands
  • Stenvert L.S. Drop Department of Pediatrics, Division of Endocrinology ,Erasmus University MC-Sophia Rotterdam, the Netherlands

Abstract

Objective.  Early diagnosis of congenital adrenal hyperplasia (CAH) and the need for long term treatment are of great concern to the medical community. The aim of this study was to evaluate the effectiveness of glucocorticoid treatment-monitoring based on salivary 17-hydroxyprogesterone (17-OHP) and androstenedione measurements in CAH patients in Semarang, Indonesia in comparison to patients treated in Rotterdam, the Netherlands.

 

Methodology. 25 out of 43 patients with CAH from Semarang, Indonesia were included in the study. For comparison, twenty CAH patients from the Sophia Children’s Hospital/ Erasmus Medical Center Rotterdam, the Netherlands were included. The effects of treatment were monitored by estimations of the steroids 17-OHP and androstenedione in saliva. Auxology and bone age determination were recorded.

 

Result. 17-OHP and androstenedione levels were high in a substantial number of Indonesian patients under treatment but decreased after adjustment of dosage and timing. The steroid concentrations obtained after adjustment were similar to those found under comparable circumstances in patients in Rotterdam.  

 

Conclusion. Optimal treatment of CAH patients in Semarang Indonesia can be reached by introducing hydrocortisone treatment and adjusting dosage and timing on the basis of salivary steroid monitoring. However, in Indonesia the management of these patients is still constrained by the lack of diagnostic and therapeutic means.

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References

Lee PA, Houk CP, Ahmed SF, Hughes IA. Consensus statement on management of intersex disorders. International Consensus Conference on Intersex. Pediatrics. 2006;118(2):e488-500.

Hindmarsh PC. Management of the child with congenital adrenal hyperplasia. Best Pract Res Clin Endocrinol Metab. 2009;23(2):193-208.

Stikkelbroeck MM, Otten BJ. [Congenital adrenal hyperplasia: clinical aspects and neonatal screening]. Ned Tijdschr Geneeskd. 2002;146(6):246-9.

Riepe FG, Sippell WG. Recent advances in diagnosis, treatment, and outcome of congenital adrenal hyperplasia due to 21-hydroxylase deficiency. Rev Endocr Metab Disord. 2007;8(4):349-63.

Bonfig W, Pozza SB, Schmidt H, Pagel P, Knorr D, Schwarz HP. Hydrocortisone dosing during puberty in patients with classical congenital adrenal hyperplasia: an evidence-based recommendation. J Clin Endocrinol Metab. 2009;94(10):3882-8.

Groschl M, Rauh M, Dorr HG. Cortisol and 17-hydroxyprogesterone kinetics in saliva after oral administration of hydrocortisone in children and young adolescents with congenital adrenal hyperplasia due to 21-hydroxylase deficiency. J Clin Endocrinol Metab. 2002;87(3):1200-4.

Deutschbein T, Unger N, Hauffa BP, Schaaf K, Mann K, Petersenn S. Monitoring medical treatment in adolescents and young adults with congenital adrenal hyperplasia: Utility of salivary 17alpha-hydroxyprogesterone day profiles. Exp Clin Endocrinol Diabetes. 2011;119(3):131-8.

Juniarto AZ, Goossens K, Setyawati BA, Drop SL, de Jong FH, Faradz SM. Correlation between androstenedione and 17-hydroxyprogesterone levels in the saliva and plasma of patients with congenital adrenal hyperplasia. Singapore Med J. 2011;52(11):810-3.

Buken B, Safak AA, Yazici B, Buken E, Mayda AS. Is the assessment of bone age by the Greulich-Pyle method reliable at forensic age estimation for Turkish children? Forensic Sci Int. 2007;173(2-3):146-53.

Dauber A, Kellogg M, Majzoub JA. Monitoring of therapy in congenital adrenal hyperplasia. Clin Chem. 2010;56(8):1245-51.

Loechner KJ, McLaughlin JT, Calikoglu AS. Alternative strategies for the treatment of classical congenital adrenal hyperplasia: Pitfalls and promises. Int J Pediatr Endocrinol. 2010;2010:670960.

Woodside DB, Winter K, Fisman S. Salivary cortisol in children: correlations with serum values and effect of psychotropic drug administration. Can J Psychiatry. 1991;36(10):746-8.

Shimon I, Kaiserman I, Sack J. Home monitoring of 17 alpha-hydroxyprogesterone levels by filter paper blood spots in patients with 21-hydroxylase deficiency. Horm Res. 1995;44(6):247-52.

Speiser PW. Growth and development: congenital adrenal hyperplasia-glucocorticoids and height. Nat Rev Endocrinol. 2010;6(1):14-5.

Charmandari E, Hindmarsh PC, Johnston A, Brook CG. Congenital adrenal hyperplasia due to 21-hydroxylase deficiency: alterations in cortisol pharmacokinetics at puberty. J Clin Endocrinol Metab. 2001;86(6):2701-8.

Balducci R, Toscano V, Larizza D, Mangiantini A, Galasso C, Municchi G, et al. Effects of long-term growth hormone therapy on adrenal steroidogenesis in Turner syndrome. Horm Res. 1998;49(5):210-5.

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Published

2014-05-23

How to Cite

Juniarto, A. Z., Noppe, G., Maharani, N., van den Akker, E., Susanto, R., MH Faradz, S., … L.S. Drop, S. (2014). Salivary 17-hydroxyprogesterone (17-OHP) and androstenedione in monitoring efficacy of treatment among Indonesian Congenital Adrenal Hyperplasia Patients. Journal of the ASEAN Federation of Endocrine Societies, 27(2), 203. Retrieved from https://asean-endocrinejournal.org/index.php/JAFES/article/view/38

Issue

Vol. 27 No. 2 (2012): November Issue

Section

Original Articles

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