medwireNews: Age, disease severity and socioeconomic status may affect the likelihood of children being hospitalised after their initial diagnosis of salt-wasting congenital adrenal hyperplasia (CAH), say researchers.

Ming Yang and Perrin White, from the University of Texas Southwestern Medical Center in Dallas, USA, reviewed the records of 155 patients with the salt-wasting form of CAH treated at the Children’s Medical Center Dallas between January 1999 and October 2013.

Of these, 55 had 105 unplanned hospital admissions, 48 of which were for gastrointestinal infections, with urinary tract, respiratory and other infections together accounting for a further 27 admissions.

The median age of the hospitalised patients was 2 years, versus 5 years for those who had only outpatient encounters, and in the whole cohort being younger than 2 years was associated with a 3.3-fold increased risk of hospitalisation, which the researchers say is in line with younger children having an “increased susceptibility to viral infections and decreased ability to withstand stress and dehydration.”

Given also the risk of an adrenal crisis in CAH patients if they are unable to take oral glucocorticoids due to vomiting, the team advises measures such as rotavirus immunisations to prevent gastroenteritis in these vulnerable patients.

Children with government-funded medical insurance had a 1.8-fold increased risk of hospitalisation, relative to those with commercial insurance, although this was partly due to the presence of five “frequent flyers” with 37 admissions between them.

Yang and White speculate that barriers related to low socioeconomic status may lead to poor disease management, and suggest that such patients “may benefit from case management strategies.”

They note, however, that patients with unplanned hospitalisations lived no further from the hospital than patients who were not hospitalised, and that they had more scheduled outpatient appointments.

Lastly, the team found that hospitalised patients were on a significantly higher fludrocortisone dose than those not hospitalised, at 0.18 versus 0.12 mg/m2 per day.

“Fludrocortisone dose is presumably correlated with severity of salt wasting disease and children with more severe salt wasting are more likely to require hospitalization when they become ill”, they write in Clinical Endocrinology.

By Eleanor McDermid

Clin Endocrinol 2017; Advance online publication

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