medwireNews: Findings from a database analysis suggest that salt supplementation may not influence medication doses or height and weight in infants with congenital adrenal hyperplasia (CAH).

The study, which is published in Hormone Research in Paediatrics, included data from 311 patients (153 female, 205 male) with salt-wasting CAH, born between 1999 and 2015.

The frequency of salt supplementation increased during this period, from 15.2% among patients born between 1999 and 2004 to 34.4% and 37.5% for those born in 2005–2010 and 2011–2015, respectively. The total 86 (27.7%) infants given salt supplementation received an average dose of 0.9 mmol/kg per day during the first year of life, after which it was discontinued in most patients.

Walter Bonfig (Klinikum Wels-Grieskirchen, Austria) and study co-authors note that one reason cited for not using salt supplementation is the belief that “sufficient fludrocortisone doses are equally effective in stabilizing sodium concentrations and avoiding salt-wasting crises.”

Although salt supplementation could theoretically reduce the required fludrocortisone dose, the team found that the average dose during the first year of life was not significantly different between infants who did and did not receive salt supplementation, at 208 and 188 µg/m2 per day. However, they describe these doses as generally “rather high” and suggest that overdosing could have obscured any effect of salt supplementation on patients’ fludrocortisone needs.

There were also no differences in patients’ systolic or diastolic blood pressure, which is increased by fludrocortisone treatment, but this information was available for only a third of the patients in the study. The proportions of patients with blood pressure above the 95th centile did not significantly differ between the groups, at a respective 21.0% and 13.6% of patients with and without salt supplementation.

Likewise, the average hydrocortisone dose did not differ between infants who did and did not receive salt supplementation, at 18.1 and 18.9 mg/m2 per day, respectively, and the same was true for BMI standard deviation scores (SDS), at a corresponding –0.1 and –0.2, and target-height-corrected height SDS, at +0.3 and 0.0.

There were no adrenal crises in either group of patients after they started treatment, the researchers note.

By Eleanor McDermid

Horm Res Paediatr 2017; Advance online publication

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