Impact of Newborn Screening on Clinical Presentation of Congenital Adrenal Hyperplasia.

Rūta Navardauskaitė,Rasa Verkauskienė,Darius Čereškevičius,Jurgita Songailienė,Marius Šukys,Marija Smirnova,Kristina Grigalionienė,Algirdas Utkus,Kornelija Banevičiūtė,Giedrė Mockevicienė

doi:10.3390/medicina57101035

Rūta Navardauskaitė, Rasa Verkauskienė + Show 8 more

Open Access

https://doi.org/10.3390/medicina57101035

Copy DOI

Abstract

Background and Objectives: The main reason for Newborn screening (NBS) for congenital adrenal hyperplasia (CAH) is to prevent adrenal insufficiency that can lead to life-threatening conditions. On the other hand, screening programs are not always sensitive and effective enough to detect the disease. We aimed to evaluate impact of the national NBS on the clinical presentation of patients with CAH in Lithuania. Materials and Methods: A retrospective study was performed on data of 88 patients with CAH from 1989 to 2020. Patients with confirmed CAH were divided into two groups: (1) 75 patients diagnosed before NBS: 52 cases with salt-wasting (SW), 21 with simple virilising (SV) and two with non-classical (NC) form; (2) 13 patients diagnosed with NBS: 12 cases with SW and 1 case with SV form. For the evaluation of NBS effectiveness, data of only male infants with salt-wasting CAH were analysed (n = 36, 25 unscreened and nine screened). Data on gestational age, birth weight, weight, symptoms, and laboratory tests (serum potassium and sodium levels) on the day of diagnosis, were analysed. Results: A total of 158,486 neonates were screened for CAH from 2015 to 2020 in Lithuania and CAH was confirmed in 13 patients (12 SW, one–SV form), no false negative cases were found. The sensitivity and specificity of NBS program for classical CAH forms were 100%; however, positive predictive value was only 4%. There were no significant differences between unscreened and screened male infant groups in terms of age at diagnosis, serum potassium, and serum sodium levels. Significant differences were found in weight at diagnosis between the groups (−1.67 ± 1.12 SDS versus 0.046 ± 1.01 SDS of unscreened and screened patients respectively, p = 0.001). Conclusions: The sensitivity and specificity of NBS for CAH program were 100%, but positive predictive value—only 4%. Weight loss was significantly lower and the weight SDS at diagnosis was significantly higher in the group of screened patients.

Highlights

Congenital adrenal hyperplasia (CAH) is one of the life-threatening disorders in neonates
For the evaluation of Newborn screening (NBS) effectiveness, data of only male infants with SW CAH were analyzed whereas during the prenatal period, testosterone hypersecretion does not result in any visible signs for male infants and adrenal insufficiency occurs at 2 to 3 weeks of age with severe hyperkalemia, hyponatremia, and hypovolemic shock
There were 158,987 live births registered in Lithuania between the 1st of January 2015 and 31st of December 2020

Summary

Introduction

Congenital adrenal hyperplasia (CAH) is one of the life-threatening disorders in neonates. The clinical symptoms depend on specific CYP21A2 mutations and range from mild to a life-threatening condition—adrenal insufficiency. Testosterone hypersecretion does not result in any visible signs for male infants and adrenal insufficiency occurs at 2 to 3 weeks of age with severe hyperkalemia, hyponatremia, and hypovolemic shock [6]. The different clinical presentations of CAH are classified as salt-wasting (SW), the most severe form, which may result in acute salt loss and a circulatory collapse during the first weeks of life, simple virilizing (SV)—the less severe form with prenatal virilization but without life-threatening salt loss, and the non-classical (NC) CAH—a mild form with slightly elevated androgen levels. More than 2/3 of CAH cases are severe SW forms of the disease. [7]

Objectives

Methods

Results

Discussion

Conclusion