{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,12]],"date-time":"2026-08-12T10:29:18Z","timestamp":1786530558501,"version":"build-2736575974"},"reference-count":29,"publisher":"Oxford University Press (OUP)","issue":"2","license":[{"start":{"date-parts":[[2026,8,5]],"date-time":"2026-08-05T00:00:00Z","timestamp":1785888000000},"content-version":"vor","delay-in-days":4,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,8,3]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To assess plasma renin levels, fludrocortisone dosing, and their relationships with electrolytes, blood pressure, and early growth in children with 21-hydroxylase deficiency (21OHD).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>Retrospective single-centre longitudinal cohort study.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Patients born 2013-2022 and followed until age 3 years were included. Serial plasma renin, fludrocortisone dose, sodium chloride supplementation, electrolytes, and blood pressure were extracted from clinical records. Fludrocortisone trajectories and repeated-measures associations were analysed using mixed-effects models. Plasma renin was categorized as below, within, or above the assay reference range. Growth at 1 and 3 years was assessed as height SD score relative to target height.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Twenty-eight children were included. Fludrocortisone dosing peaked around 3 months (estimated mean 130\u2005\u00b5g\/day, 95% CI: 115-144) and declined to a plateau after 1 year (84\u2005\u00b5g\/day, 95% CI: 72-96). Higher renin levels were associated with lower sodium (approximately 139.7 vs 136.9\u2005mmol\/L) and higher potassium (4.09 vs 4.81\u2005mmol\/L). Suppressed renin levels were associated with the highest predicted probability of hypertension. Renin levels did not affect linear growth.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Renin suppression in early childhood is associated with increased hypertension risk, whereas higher renin was not associated with growth or electrolyte abnormalities. These findings emphasize the importance of avoiding mineralocorticoid overtreatment and monitoring blood pressure carefully.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/ejendo\/lvag146","type":"journal-article","created":{"date-parts":[[2026,8,3]],"date-time":"2026-08-03T11:23:31Z","timestamp":1785756211000},"page":"271-280","source":"Crossref","is-referenced-by-count":0,"title":["The role of renin, fludrocortisone, and hypertension in early childhood in patients with congenital adrenal hyperplasia"],"prefix":"10.1093","volume":"195","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6010-0930","authenticated-orcid":false,"given":"Xinyi","family":"Chin","sequence":"first","affiliation":[{"name":"Department of Pediatrics, Endocrinology Service, KK Women's and Children's Hospital , Singapore 229899 ,","place":["Singapore"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-9717-399X","authenticated-orcid":false,"given":"Jan C","family":"van der Meijden","sequence":"additional","affiliation":[{"name":"Division of Pediatric Metabolic Medicine, Department of Pediatrics, Amalia Children's Hospital, Radboud University Medical Center , GA Nijmegen 6525 ,","place":["The Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5417-8272","authenticated-orcid":false,"given":"Antonius E","family":"van Herwaarden","sequence":"additional","affiliation":[{"name":"Department of Laboratory Medicine, Radboud University Medical Center , GA Nijmegen 6525 ,","place":["The Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0181-0403","authenticated-orcid":false,"given":"Hedi L","family":"Claahsen-van der Grinten","sequence":"additional","affiliation":[{"name":"Division of Pediatric Endocrinology, Department of Pediatrics, Amalia Children's Hospital, Radboud University Medical Center , GA Nijmegen 6525 ,","place":["The Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2026,8,5]]},"reference":[{"issue":"3","key":"2026081205161822700_lvag146-B1","doi-asserted-by":"publisher","first-page":"245","DOI":"10.1210\/edrv.21.3.0398","article-title":"Congenital adrenal hyperplasia due to 21-hydroxylase deficiency","volume":"21","author":"White","year":"2000","journal-title":"Endocr Rev"},{"issue":"9","key":"2026081205161822700_lvag146-B2","doi-asserted-by":"publisher","first-page":"4414","DOI":"10.1210\/en.2008-1498","article-title":"Low renal mineralocorticoid receptor expression at birth contributes to partial aldosterone resistance in neonates","volume":"150","author":"Martinerie","year":"2009","journal-title":"Endocrinology"},{"issue":"2","key":"2026081205161822700_lvag146-B3","doi-asserted-by":"publisher","first-page":"74","DOI":"10.1542\/pir.2022-005617","article-title":"Congenital adrenal hyperplasia","volume":"45","author":"Fraga","year":"2024","journal-title":"Pediatr Rev"},{"issue":"8","key":"2026081205161822700_lvag146-B4","doi-asserted-by":"publisher","first-page":"714","DOI":"10.1001\/jama.2025.5485","article-title":"Adrenal insufficiency in adults: a review","volume":"334","author":"Vaidya","year":"2025","journal-title":"JAMA"},{"issue":"10","key":"2026081205161822700_lvag146-B5","doi-asserted-by":"publisher","first-page":"858","DOI":"10.1007\/BF02282834","article-title":"Value of direct measurement of active renin concentrations in congenital adrenal hyperplasia due to 21-hydroxylase deficiency","volume":"155","author":"Kr\u00fcger","year":"1996","journal-title":"Eur J Pediatr"},{"issue":"10","key":"2026081205161822700_lvag146-B6","doi-asserted-by":"publisher","first-page":"1811","DOI":"10.1093\/clinchem\/37.10.1811","article-title":"Plasma renin activity and plasma prorenin assays","volume":"37","author":"Sealey","year":"1991","journal-title":"Clin Chem"},{"key":"2026081205161822700_lvag146-B7","doi-asserted-by":"publisher","first-page":"110644","DOI":"10.1016\/j.clinbiochem.2023.110644","article-title":"Pediatric reference intervals for endocrine markers in healthy children and adolescents on the Liaison XL (DiaSorin) immunoassay system","volume":"120","author":"Miller","year":"2023","journal-title":"Clin Biochem"},{"issue":"1","key":"2026081205161822700_lvag146-B8","doi-asserted-by":"publisher","first-page":"15","DOI":"10.1016\/s0009-8981(98)00044-8","article-title":"Immunoreactive renin concentrations in healthy children from birth to adolescence","volume":"274","author":"Kr\u00fcger","year":"1998","journal-title":"Clin Chim Acta"},{"issue":"6","key":"2026081205161822700_lvag146-B9","doi-asserted-by":"publisher","first-page":"871","DOI":"10.1111\/cen.12498","article-title":"Blood pressure, fludrocortisone dose and plasma renin activity in children with classic congenital adrenal hyperplasia due to 21-hydroxylase deficiency followed from birth to 4 years of age","volume":"81","author":"Bonfig","year":"2014","journal-title":"Clin Endocrinol (Oxf)"},{"issue":"6","key":"2026081205161822700_lvag146-B10","doi-asserted-by":"publisher","first-page":"377","DOI":"10.30476\/ijms.2023.98508.3058","article-title":"Congenital adrenal hyperplasia in children: the relationship between plasma renin activity and hypertension","volume":"49","author":"Lubis","year":"2024","journal-title":"Iran J Med Sci"},{"issue":"12","key":"2026081205161822700_lvag146-B11","doi-asserted-by":"publisher","first-page":"4429","DOI":"10.1210\/jc.2012-2102","article-title":"Clinical characteristics of a cohort of 244 patients with congenital adrenal hyperplasia","volume":"97","author":"Finkielstain","year":"2012","journal-title":"J Clin Endocrinol Metab"},{"issue":"4","key":"2026081205161822700_lvag146-B12","doi-asserted-by":"publisher","first-page":"528","DOI":"10.1111\/cen.13086","article-title":"Hypertension in children with congenital adrenal hyperplasia","volume":"85","author":"Maccabee-Ryaboy","year":"2016","journal-title":"Clin Endocrinol (Oxf)"},{"issue":"2","key":"2026081205161822700_lvag146-B13","doi-asserted-by":"publisher","first-page":"266","DOI":"10.1093\/ajh\/hpv087","article-title":"Blood pressure in a large cohort of children and adolescents with classic adrenal hyperplasia (CAH) due to 21-hydroxylase deficiency","volume":"29","author":"Bonfig","year":"2016","journal-title":"Am J Hypertens"},{"key":"2026081205161822700_lvag146-B14"},{"key":"2026081205161822700_lvag146-B15","author":"TNO"},{"issue":"1","key":"2026081205161822700_lvag146-B16","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1542\/peds.79.1.1","article-title":"Report of the second task force on blood pressure control in children\u20131987. National Heart, Lung, and Blood Institute, Bethesda, Maryland","volume":"79","author":"Task Force","year":"1987","journal-title":"Pediatrics"},{"issue":"3","key":"2026081205161822700_lvag146-B17","doi-asserted-by":"publisher","first-page":"e20171904","DOI":"10.1542\/peds.2017-1904","article-title":"Clinical practice guideline for screening and management of high blood pressure in children and adolescents","volume":"140","author":"Flynn","year":"2017","journal-title":"Pediatrics"},{"issue":"7","key":"2026081205161822700_lvag146-B18","doi-asserted-by":"publisher","first-page":"2611","DOI":"10.1073\/pnas.1300057110","article-title":"Genotype-phenotype correlation in 1,507 families with congenital adrenal hyperplasia owing to 21-hydroxylase deficiency","volume":"110","author":"New","year":"2013","journal-title":"Proc Natl Acad Sci U S A"},{"issue":"1","key":"2026081205161822700_lvag146-B19","doi-asserted-by":"publisher","first-page":"7","DOI":"10.1159\/000481775","article-title":"Sodium chloride supplementation is not routinely performed in the majority of German and Austrian infants with classic salt-wasting congenital adrenal hyperplasia and has no effect on linear growth and hydrocortisone or fludrocortisone dose","volume":"89","author":"Bonfig","year":"2018","journal-title":"Horm Res Paediatr"},{"issue":"2","key":"2026081205161822700_lvag146-B20","doi-asserted-by":"publisher","first-page":"147","DOI":"10.6061\/clinics\/2013(02)oa05","article-title":"Mineralocorticoid replacement during infancy for salt wasting congenital adrenal hyperplasia due to 21-hydroxylase deficiency","volume":"68","author":"Gomes","year":"2013","journal-title":"Clinics (Sao Paulo)"},{"issue":"5","key":"2026081205161822700_lvag146-B21","doi-asserted-by":"publisher","first-page":"328","DOI":"10.1159\/000308891","article-title":"Blood pressure in the first year of life in children with congenital adrenal hyperplasia due to 21-hydroxylase deficiency: a pilot study","volume":"74","author":"Mooij","year":"2010","journal-title":"Horm Res Paediatr"},{"issue":"5","key":"2026081205161822700_lvag146-B22","doi-asserted-by":"publisher","first-page":"587","DOI":"10.1530\/EJE-21-1085","article-title":"Treatment of congenital adrenal hyperplasia in children aged 0-3 years: a retrospective multicenter analysis of salt supplementation, glucocorticoid and mineralocorticoid medication, growth and blood pressure","volume":"186","author":"Neumann","year":"2022","journal-title":"Eur J Endocrinol"},{"issue":"2","key":"2026081205161822700_lvag146-B23","doi-asserted-by":"publisher","first-page":"76","DOI":"10.1016\/j.siny.2016.11.002","article-title":"Renal adaptive changes and sodium handling in the fetal-to-newborn transition","volume":"22","author":"Segar","year":"2017","journal-title":"Semin Fetal Neonatal Med"},{"issue":"2","key":"2026081205161822700_lvag146-B24","doi-asserted-by":"publisher","first-page":"118","DOI":"10.1203\/00006450-198202000-00008","article-title":"Plasma renin activity and the response to sodium depletion in salt-losing congenital adrenal hyperplasia","volume":"16","author":"Keenan","year":"1982","journal-title":"Pediatr Res"},{"issue":"4","key":"2026081205161822700_lvag146-B25","doi-asserted-by":"publisher","first-page":"346","DOI":"10.1111\/cen.14959","article-title":"Mineralocorticoid replacement therapy in salt-wasting congenital adrenal hyperplasia","volume":"101","author":"Lang","year":"2024","journal-title":"Clin Endocrinol (Oxf)"},{"issue":"11","key":"2026081205161822700_lvag146-B26","doi-asserted-by":"publisher","first-page":"4043","DOI":"10.1210\/jc.2018-01865","article-title":"Congenital adrenal hyperplasia due to steroid 21-hydroxylase deficiency: an endocrine society clinical practice guideline","volume":"103","author":"Speiser","year":"2018","journal-title":"J Clin Endocrinol Metab"},{"issue":"Suppl 1","key":"2026081205161822700_lvag146-B27","doi-asserted-by":"publisher","first-page":"12","DOI":"10.4274\/jcrpe.galenos.2024.2024-6-26-S","article-title":"Treatment and follow-up of congenital adrenal hyperplasia due to 21-hydroxylase deficiency in childhood and adolescence","volume":"17","author":"Peltek Kendirci","year":"2025","journal-title":"J Clin Res Pediatr Endocrinol"},{"issue":"5","key":"2026081205161822700_lvag146-B28","doi-asserted-by":"publisher","first-page":"529","DOI":"10.1093\/ejendo\/lvaf060","article-title":"Blood pressure and its associations in 554 children and young people with congenital adrenal hyperplasia","volume":"192","author":"Lawrence","year":"2025","journal-title":"Eur J Endocrinol"},{"issue":"2","key":"2026081205161822700_lvag146-B29","doi-asserted-by":"publisher","first-page":"e230370","DOI":"10.1530\/EC-23-0370","article-title":"Performance of renin assays in selecting fludrocortisone dose in children with adrenal disorders","volume":"13","author":"Morris","year":"2024","journal-title":"Endocr Connect"}],"container-title":["European Journal of Endocrinology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/ejendo\/advance-article-pdf\/doi\/10.1093\/ejendo\/lvag146\/70493778\/lvag146.pdf","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/ejendo\/article-pdf\/195\/2\/271\/70493778\/lvag146.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/ejendo\/article-pdf\/195\/2\/271\/70493778\/lvag146.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,12]],"date-time":"2026-08-12T09:35:39Z","timestamp":1786527339000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/ejendo\/article\/195\/2\/271\/8752471"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8]]},"references-count":29,"journal-issue":{"issue":"2","published-print":{"date-parts":[[2026,8,3]]}},"URL":"https:\/\/doi.org\/10.1093\/ejendo\/lvag146","relation":{},"ISSN":["0804-4643","1479-683X"],"issn-type":[{"value":"0804-4643","type":"print"},{"value":"1479-683X","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2026,8]]},"published":{"date-parts":[[2026,8]]}}}