Are you passionate about advancing our understanding of congenital adrenal hyperplasia and improving patient outcomes? Join our research team to explore innovative biomarkers and treatment strategies in pediatric endocrinology. Congenital adrenal hyperplasia (CAH) is a rare group of diseases of the adrenal cortex characterized by impaired cortisol production and accumulation of precursor steroids (PS) and adrenal androgens (AA). In this project, we will focus on patients with CAH due to 21-hydroxylase deficiency, the most common form of CAH with a prevalence of 1:15,000.
Patients require lifelong cortisol replacement treatment based on international guidelines, yet most adult patients develop short- and long-term complications. Patients are at risk of developing a life-threatening adrenal crisis in situations of illness. Therefore, parents and patients must be educated regularly to increase their cortisol dosages adequately in situations of stress.
Well-known long-term complications in undertreated patients with chronically elevated AA include infertility, cardiovascular, and metabolic diseases, leading to a reduced quality of life. The excess of AA is an important hallmark responsible for many complications. Therefore, treatment aims to decrease AA concentrations within the normal range with frequent monitoring.
The current approach measuring androstenedione cannot differentiate between adrenal and gonadal origin of androgens. Notably, adrenal-specific 11-oxygenated androgens (11OA) are the most abundant AA in 21OHD. Thus, 11OA are promising biomarkers for treatment monitoring of CAH.
For clinical implementation, longitudinal studies are necessary, especially in children and infants. In this project, the measurement method of 11OA in saliva will be developed, and the role of 11OA will be studied in a clinical cohort of patients with CAH. Salivary measurement of AA enables non-invasive home-based sample collection over several time points per day. To enable saliva collection in young children (<4 years), we will evaluate a new saliva collection tool.
We want to investigate the efficacy and clinical implementation of salivary 11OA as new biomarkers for treatment control in pediatric 21OHD. We hypothesize that measuring 11OA in saliva will improve treatment control and consequently long-term clinical outcomes in patients with 21OHD.
Furthermore, to improve hormonal control and especially to lower AA, new treatment options are being explored. Since May 2021, a controlled-release cortisol preparation has been authorized by the EMA and has been available on the Dutch market since March 2022. It is registered for adults and adolescents aged 12 years and older. Dose recommendations for this age group are not given, and treatment is based on recommendations for adult schedules. Therefore, there is a need for a more protocolized treatment to prospectively evaluate the effects of this preparation.
Tasks and responsibilities - Unravelling the clinical importance of AA in CAH disease.
- Optimalization of treatment regimen for CAH patients.
- Correlation obtained research data with clinical data.
- Generate and critically analyze the data in order to prepare scientific publications and presents findings at scientific meetings.
- Supervise MSc and/or BSc students.
- Participation in the graduate school of Radboudumc.