Prevalence of psychiatric comorbidities in females with classic congenital adrenal hyperplasia

Behzad Sorouri Khorashad; Oumaima Kaabi; Melissa D Gardner; Darios Getahun; Michael Goodman; Timothy L Lash; Peter A Lee; Joshua May; Courtney McCracken; Maria Muzik; Suma Vupputuri; Rami Yacoub; David E Sandberg

doi:10.1210/clinem/dgae831

Prevalence of psychiatric comorbidities in females with classic congenital adrenal hyperplasia

J Clin Endocrinol Metab. 2024 Dec 4:dgae831. doi: 10.1210/clinem/dgae831. Online ahead of print.

Authors

Behzad Sorouri Khorashad^{1

2

3}, Oumaima Kaabi⁴, Melissa D Gardner¹, Darios Getahun^{5

6}, Michael Goodman⁴, Timothy L Lash⁴, Peter A Lee⁷, Joshua May⁵, Courtney McCracken⁸, Maria Muzik^{2

9}, Suma Vupputuri¹⁰, Rami Yacoub⁴, David E Sandberg¹

Affiliations

¹ Susan B. Meister Child Health and Evaluation Research Center, University of Michigan Medical School, Ann Arbor, MI, USA.
² Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA.
³ Huntsman Mental Health Institute, University of Utah, Salt Lake City, UT, USA.
⁴ Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA.
⁵ Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA.
⁶ Department of Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, CA, USA.
⁷ Division of Endocrinology, Department of Pediatrics, Penn State College of Medicine, Hershey, PA, USA.
⁸ Center for Research and Evaluation, Kaiser Permanente Georgia, Atlanta, GA, USA.
⁹ Department of Obstetrics & Gynecology, University of Michigan, Ann Arbor, MI, USA.
¹⁰ Mid-Atlantic Permanente Research Institute, Kaiser Permanente Mid-Atlantic States, Rockville, MD, USA.

PMID: 39656806
DOI: 10.1210/clinem/dgae831

Abstract

Context: Although the increased burden of mental health problems among patients with classic 46,XX congenital adrenal hyperplasia (CAH) is well-documented, it remains unclear if this comorbidity is attributable to the burden of living with a chronic medical condition or the potential psychosocial/sexual consequences of being born with a difference of sex development (DSD) and its associated clinical management.

Objectives: To compare the prevalence of psychiatric diagnoses among CAH patients and three reference groups: matched males and females from the general population, and females with type-1 diabetes mellitus (T1DM).

Design: Retrospective cross-sectional study.

Setting: Three large integrated health systems.

Participants: CAH patients (n=115), general population male and female referents (n=1150 per group), and 66,002 female T1DM referents.

Results: The prevalence of depression, anxiety, personality disorders, and suicidal ideation was higher among CAH participants than in males and females from the general population, but similar to or lower than in T1DM referents. CAH patients were more likely to be diagnosed with neurodevelopmental disorders compared to both female reference groups, whereas the prevalence of elimination disorders (predominantly enuresis) and gender dysphoria was higher in the CAH cohort than in all reference groups.

Conclusion: Females with classic CAH experience a higher burden of psychiatric illness, including anxiety and depression, compared to demographically similar men and women in the general population. The similar psychiatric burden between females with CAH and T1DM suggests that morbidity may be influenced by the challenges associated with managing a chronic condition. Investigating long-term mental health trajectories in this population will require longitudinal studies.

Keywords: congenital adrenal hyperplasia; differences of sex development; disorders of sex development; psychiatric comorbidities; type-1 diabetes mellitus.

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