Cecconi Elisabetta, Gasperi Maurizio, Genovesi Maura, Bogazzi Fausto, Grasso Lucia, Cetani Filomena, Procopio Massimo, Marcocci Claudio, Bartalena Luigi, Martino Enio
Department of Endocrinology and Metabolism, University of Pisa, Ospedale, Cisanello, Via Paradisa 2, 56124 Pisa, Italy.
Eur J Endocrinol. 2006 Jul;155(1):41-5. doi: 10.1530/eje.1.02181.
To investigate, in a large group of postmenopausal primary hyperparathyroidism (PHP) women, whether the concomitance of GH deficiency (GHD) may contribute to the development of changes in bone mineral density (BMD).
GH secretion, bone status and metabolism were investigated in 50 postmenopausal women with PHP and in a control group of 60 women with no evidence of PHP, matched for age, age at menopause and body mass index (BMI).
GH response to growth hormone-releasing hormone (GHRH)+arginine (Arg), femoral neck BMD (g/cm2) by dual energy X-ray absorptiometry, BMI, serum-ionized calcium, parathyroid hormone (PTH) and markers of bone remodelling were evaluated in all patients and controls.
Among PHP patients, GH secretion was reduced (8.8 +/- 4.2 microg/l, range 1.1-16.5 microg/l) in 34 patients and normal (28.7 +/- 11.8 microg/l, range 17.9-55.7 microg/l) in the remaining 16 (P < 0.05), no women in the control group had GHD (peak GH 33.8 +/- 10.9 microg/l, range 21.7 +/- 63.2 microg/l). Osteoporosis (T-score < - 2.5) and osteopenia (T-score > -2.5 and < -1) were found in 73.5 and 17.6% of GHD patients, in 37.5 and 43.7% of patients with normal GH secretion and 3.1 and 27% of controls. T-score and BMD were not correlated with ionized calcium, age, age at menopause, BMI, GH peak and IGF-I but were correlated with serum PTH levels in both groups. T-score was correlated with serum levels of markers of bone remodelling only in PHP patients with GHD.
Concomitant impairment of GH secretion may play a pathogenetic role in the occurrence of changes in bone mass observed in PHP and contribute to make them more severe.
在一大群绝经后原发性甲状旁腺功能亢进症（PHP）女性中，研究生长激素缺乏（GHD）的并存是否可能导致骨矿物质密度（BMD）变化的发生。
对50名绝经后PHP女性和60名无PHP证据的对照组女性进行生长激素分泌、骨状态和代谢研究，两组在年龄、绝经年龄和体重指数（BMI）方面相匹配。
评估所有患者和对照组对生长激素释放激素（GHRH）+精氨酸（Arg）的生长激素反应、通过双能X线吸收法测定的股骨颈骨密度（g/cm²）、BMI、血清离子钙、甲状旁腺激素（PTH）以及骨重塑标志物。
在PHP患者中，34例患者生长激素分泌减少（8.8±4.2μg/L，范围1.1 - 16.5μg/L），其余16例患者生长激素分泌正常（28.7±11.8μg/L，范围17.9 - 55.7μg/L）（P<0.05），对照组中无女性存在GHD（生长激素峰值33.8±10.9μg/L，范围21.7 - 63.2μg/L）。GHD患者中骨质疏松（T值<-2.5）和骨量减少（T值>-2.5且<-1）的发生率分别为73.5%和17.6%，生长激素分泌正常的患者中分别为37.5%和43.7%，对照组中分别为3.1%和27%。两组中，T值和骨密度与离子钙、年龄、绝经年龄、BMI、生长激素峰值和胰岛素样生长因子 - I均无相关性，但与血清PTH水平相关。仅在伴有GHD的PHP患者中，T值与骨重塑标志物的血清水平相关。
生长激素分泌的并存损害可能在PHP患者骨量变化的发生中起致病作用，并促使其更为严重。
