WC228 Congenital Adrenal Hyperplasia and Mental Health

Congenital adrenal hyperplasia (CAH) is a genetic condition in which the adrenal glands cannot make enough cortisol (and often aldosterone), requiring lifelong hormone replacement and “stress dosing” during illness, injury, or surgery to avoid adrenal crisis — a hidden daily burden that rarely appears on growth charts alone.

Harasymiw et al. 2023 · Frontiers in Endocrinology · PMID 37664854 · US insurance-claims cohort of 1,626 children/young adults with CAH (1,056 commercial + 570 Medicaid), ages 4–25.

Privately insured CAH youth: 1.7× depressive disorder, 1.7× anxiety disorder, 1.7× antidepressant fill vs peers (aPR 1.7).
Medicaid-insured CAH youth: gap wider — about 2.0–2.5× (depression aPR ~2.3 reported on page).
Gap widens further in the 18–25 transition from pediatric to adult endocrinology.

Honest nuance (Sonnet 5): a prior smaller US children’s-hospital study (n=1,647 across six hospitals) found no overall increase in depression risk and somewhat lower anxiety odds among girls with CAH. Findings vary by population and measurement. The claims study’s strength is sample size and insured-peer comparison; both results are cited on the page.

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