Glucocorticoid Dose and Type are Associated with Depression Scores in Youth with Classical Congenital Adrenal Hyperplasia

Objective: Adults with classical congenital adrenal hyperplasia (CAH) exhibit a higher lifetime prevalence of depression, but little is known about onset or etiology of mood disorders in this population. We therefore aimed to assess depression in youth with CAH, compared to controls, using the Children’s Depression Inventory (CDI). Methods: Youth with classical CAH due to 21-hydroxylase deficiency and age- and sex-matched controls completed the CDI and had analyte and genetic testing. Results: A total of 31 patients with CAH and 36 controls were included. Youth with CAH exhibited CDI measures that differed significantly by glucocorticoid dose and type. For glucocorticoid dose, significant correlations were found between CDI total T-score (r=0.42, p<0.05), as well as multiple subscores. Dose also predicted total T-score (β=1.75), Emotional-Problems (β=1.41), Negative-Self-Esteem (β=1.91), Functional-Problems (β=1.90), Ineffectiveness (β=1.56), and Interpersonal-Problems (β=2.11) (all p<0.01). For glucocorticoid type [dexamethasone n=7, hydrocortisone (HC) n=24], scores were higher in patients treated with dexamethasone for total T-score [dexamethasone: 59 (53.5-72), HC: 50 (43.75-55.75)], Emotional-Problems [dexamethasone: 63 (51.0-67.0), HC: 45 (42.0-56.5)], and Negative-Self-Esteem [dexamethasone: 53 (50.0-73.5), HC: 44 (44.0-51.0)] (all p<0.05). Conclusion: Higher HC doses and use of dexamethasone were both found to be associated with higher CDI scores in children and adolescents with classical CAH.