TOPLINE

Congenital adrenal hyperplasia (CAH) was linked to a heavy lifelong healthcare burden, with hospitalisations peaking during infancy rather than at older age as seen in the general population. Endocrine and metabolic conditions were the leading reason for admission across all age groups, and individuals with CAH also had more comorbidities per hospital stay, longer hospital and ICU stays, and a higher likelihood of requiring mechanical ventilation.

METHODOLOGY

• Researchers conducted a retrospective cohort study using nationwide Swiss hospital discharge data to evaluate hospitalisation patterns and in-hospital outcomes in individuals with CAH across the entire lifespan.
• They analysed data from 2020 hospitalisations of individuals with CAH (mean age, 41.8 years; 61.3% female individuals) between 2012 and 2022, compared with data from 12,567,815 hospitalisations of those without CAH (mean age, 53.7 years; 53.7% female individuals).
• Among individuals with CAH, 147 were neonates and infants (age, 0-12 months), 137 were young children (age, 1-4 years), 218 were children and adolescents (age, 5-19 years), and 1518 were adults (age ≥ 20 years).
• The primary outcome was the incidence of hospitalisations across age groups; secondary outcomes were the number of diagnoses per hospitalisation and in-hospital outcomes including the total length of stay (LOS) in the hospital, ICU admission, length of ICU stay, mechanical ventilation, and in-hospital mortality.
• Propensity score matching (accounting for sex, nationality, admission type, and insurance status) was performed to compare in-hospital outcomes between individuals with and without CAH.

TAKEAWAY

• Among individuals with CAH, incidence rates of hospitalisation peaked in neonates and young children; however, among those without CAH, the rates increased predominantly during adulthood, particularly at older ages. In propensity score-matched analyses, those with CAH had significantly higher odds of hospitalisation for endocrine and metabolic disorders across all age groups and for infectious diseases from childhood through adulthood.
• Individuals with CAH experienced up to a twofold higher mean number of diagnoses per hospitalisation than the unmatched control group across the lifespan. Infants with CAH had an average of 5.5 diagnoses per hospitalisation, a burden reached in those without CAH only around the age of 60 years.
• Individuals with CAH had a longer total hospital LOS across all age groups, with effects most pronounced in neonates and infants (coefficient, 5.71; 95% CI, 2.38-9.04). Those with CAH also experienced higher odds of ICU admission and longer ICU stays.
• Neonates and infants with CAH had significantly higher odds of requiring mechanical ventilation than those without CAH (odds ratio, 2.79; 95% CI, 1.11-7.02). No significant difference in in-hospital mortality was observed between those with and without CAH.

IN PRACTICE

"CAH was found to be associated with a substantial lifelong hospital care burden, characterized by markedly elevated hospitalization rates in early childhood, greater multimorbidity from birth, and increased ICU use and length of stay compared with the general population. Much of the excess risk is concentrated in neonates and infants, highlighting early life as a particularly vulnerable period," the authors wrote.

SOURCE

This study was led by Livia Hafner, MMed, Medical University Department, Clinic for Endocrinology, Diabetes and Metabolism, Cantonal Hospital Aarau, Aarau, Switzerland. It was published online on September 09, 2026, in The Journal of Clinical Endocrinology & Metabolism.

LIMITATIONS

The retrospective design may have introduced risks for misclassification and underreporting. Data on the diagnosis of CAH could not be verified using outpatient records. Data on laboratory values, outpatient settings, and medications or prescriptions were lacking.

DISCLOSURES

This study received support from Kantonsspital Aarau AG. The authors declared having no competing interests.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.