Gonadal Changes In Congenital Adrenal Hyperplasia Patients
NCT ID: NCT04903587
Last Updated: 2021-12-30
Study Results
The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.
Basic Information
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UNKNOWN
50 participants
OBSERVATIONAL
2021-10-01
2022-11-30
Brief Summary
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* assess the patients' radiological findings in relation to their hormonal profile.
* early management and prevention of complications resulting from possible gonadal dysfunction.
Detailed Description
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The common cause of infertility in males with CAH is testicular adrenal rest tumours (TARTs) , which have been well documented in CAH male patients, with an incidence up to 94%. They could be easily imaged by US and MRI studies. TARTs are associated with the risk of seminal duct obstruction, leading to azoospermia and permanent damage of the surrounding testicular tissue. TARTs can present as single nodules , and as multiple nodules in 16% of patients. Increasing the dosage of hormone therapy can cause early TARTs lesions to shrink or completely resolve, while advanced lesions may require surgical removal .
High prevalence of impaired fertility is not restricted to men; as it was reported also in women with CAH. Androgen excess is usually implicated in girls and women with CAH for whom medical treatment is unavailable or who are noncompliant with their therapy . Adrenal androgens act either directly or through the dysfunction caused at the hypothalamic pituitary axis. Interestingly, ovarian hyperandrogenism could occur even when CAH is well controlled on glucocorticoid therapy .
Females with CAH may become infertile for several reasons, such as chronic anovulation, which was demonstrated in up to 50% of the patients with non-classic CAH . Bilateral enlarged ovaries, bilateral ovarian cysts, and ovarian adrenal rest tumour (OART) may also occur and can be detected by US. OART impairs ovarian function in CAH females by displacing normal ovarian tissue and by locally producing steroids, which interfere with normal ovarian function. It should be considered when ovarian masses are detected. If detected early enough and glucocorticoid therapy is received, it is possible that it will decrease in size following suppression of ACTH levels. Polycystic ovary syndrome (PCOS) is another common condition associated with hyperandrogenism. The prevalence of PCOS is increased in women with both classical and non-classical CAH. The association of CAH with ultrasonically detected PCOS was confirmed in 83%, 40% and 3% of the adult patients, postpubertal girls and pre and peripubertal girls respectively .
Under treatment of ARTs, PCOS and other gonadal comorbidities negatively influences the quality of life as well as sexual outcomes in patients with CAH. Besides, recognizing these conditions and identifying characteristic US features of gonadal dysfunction is important, so as to avoid misdiagnosing them as malignancies, which can lead to unnecessary interventions.
Conditions
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Study Design
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CASE_ONLY
CROSS_SECTIONAL
Interventions
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Ultrasonography and MRI
Abdominal Ultrasonography and axial MRI
Eligibility Criteria
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Inclusion Criteria
* Compliant patients with regular follow up.
Exclusion Criteria
* Female patients with ovulatory dysfunction from other causes including thyroid dysfunction and hyperprolactinemia.
* Male patients with other diseases causing impairment of gonadal capacity.
5 Years
16 Years
ALL
No
Sponsors
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Ain Shams University
OTHER
Responsible Party
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Locations
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Ain Shams University
Cairo, , Egypt
Countries
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Central Contacts
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Mohamed Salah Elkholy, professor
Role: CONTACT
Phone: 01005838888
Facility Contacts
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Hasnaa Hassan Mohammed
Role: primary
Rana Abdelhakim Ahmed
Role: backup
References
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Dumic M, Duspara V, Grubic Z, Oguic SK, Skrabic V, Kusec V. Testicular adrenal rest tumors in congenital adrenal hyperplasia-cross-sectional study of 51 Croatian male patients. Eur J Pediatr. 2017 Oct;176(10):1393-1404. doi: 10.1007/s00431-017-3008-7. Epub 2017 Sep 6.
Chen HD, Huang LE, Zhong ZH, Su Z, Jiang H, Zeng J, Liu JC. Ovarian Adrenal Rest Tumors Undetected by Imaging Studies and Identified at Surgery in Three Females with Congenital Adrenal Hyperplasia Unresponsive to Increased Hormone Therapy Dosage. Endocr Pathol. 2017 Jun;28(2):146-151. doi: 10.1007/s12022-016-9461-4.
Other Identifiers
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US and MRI in CAH patients
Identifier Type: -
Identifier Source: org_study_id