HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Accepted manuscript (PDF) All Versions of this Article: EJE-07-0887v1 158/6/879    most recent Alert me when this article is cited Alert me if a correction is posted Services Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Google Scholar Articles by Chakhtoura, Z. Articles by Touraine, P. PubMed PubMed Citation Articles by Chakhtoura, Z. Articles by Touraine, P.

Impact of total cumulative glucocorticoid dose on bone mineral density in patients with 21-hydroxylase deficiency

Z Chakhtoura, Endocrinology and reproductive medicine, GH Pitie Salpetriere, Paris, France
a Bachelot, Endocrinology and reproductive medicine, GH Pitie Salpetriere, Paris, France
d Samara-boustani, Pediatrics and endocrinology, Necker hospital, Paris, France
j Ruiz, Radiology, Necker Enfants Malades Hospital, paris, France
B Donadille, Endocrinology and reproductive medicine, Saint Antoine Hospital, Paris, France
J Dulon, Endocrinology and reproductive medicine, GH Pitie Salpetriere, Paris, France
S Christin-Maitre, Endocrinology and reproductive medicine, Saint Antoine Hospital, Paris, France
c Bouvattier, Pediatrics, Saint Vincent de Paul Hospital, Paris, France
M Raux-demay, Pediatrics, Trousseau Hospital, Paris, France
P Bouchard, Paris, France
J Carel, Pediatrics, Robert Debre Hospital, Paris, France
J Leger, Paris, France
F Kuttenn, Endocrinology and reproductive medicine, GH Pitie Salpetriere, Paris, France
m Polak, pediatric endocrinology, Hopital Necker, Paris, France
P Touraine, Endocrinology and reproductive medicine, GH Pitie Salpetriere, Paris, 75651, France

Correspondence: Philippe Touraine, Email: philippe.touraine{at}psl.aphp.fr

Abstract

±Objective: It remains controversial whether long-term glucocorticoids are charged of bone demineralization in patients with congenital adrenal hyperplasia (CAH) due to 21-hydroxylase deficiency. The aim of this study was to know if cumulative glucocorticoid dose from the diagnosis in childhood to adulthood in patients with CAH had a negative impact on bone mineral density (BMD).

Design: This was a retrospective study.

Methods: Thirty-eight adult patients with classical and non-classical CAH were included. BMD was measured in the lumbar spine and femoral neck. Total cumulative (TCG) and total average (TAG) glucocorticoid doses were calculated from pediatric and adult files.

Results: We showed a difference between final and target heights (-0.82 ± 0.92 SD for women, -1.31 ±0.84 SD for men; p<0.001). Seventeen patients (44.7%) had bone demineralization (35.7% of women, 70% of men). The 28 women had higher BMD than the 10 men for lumbar (-0.26 ± 1.20 SD vs. -1.25 ± 1.33 SD; p=0.02) and femoral T-scores (0.21 ± 1.30 SD vs. -1.08 ±1.10 SD; p=0.007). In the salt-wasting group, women were almost significantly endowed with a better BMD than men (p=0.053). We found negative effects of TCG, TAG on lumbar (p<0.001, p=0.002) and femoral T-scores (p=0.006, p<0.001), predominantly during puberty. BMI was protective on BMD (p=0.006).

Conclusion: The TCG is an important factor especially during puberty for a bone demineralization in patients with 21-hydroxylase deficiency. Glucocorticoid treatment should be adapted particularly at this life period and preventive measures should be discussed in order to limit this effect.