Department of Clinical Endocrinology, Charite Campus Mitte, Charite University Medicine, D-10117 Berlin, Germany.
J Clin Endocrinol Metab. 2012 Jan;97(1):85-92. doi: 10.1210/jc.2011-2036. Epub 2011 Oct 12.
Patients with primary adrenal insufficiency (PAI) and patients with congenital adrenal hyperplasia (CAH) receive glucocorticoid replacement therapy, which might cause osteoporosis.
Questions addressed by this study were: 1) Is bone mineral density (BMD) reduced in PAI and CAH on lower glucocorticoid doses than previously reported? 2) Is BMD in PAI influenced by the type of glucocorticoid used? and 3) Does DHEA treatment affect BMD in PAI women?
We conducted a prospective, cross-sectional study including 81 PAI patients and 41 CAH patients.
BMD was measured by dual-energy x-ray absorptiometry. Serum levels of bone turnover markers, minerals, vitamins, hormones, and urinary crosslinks were measured.
PAI and CAH patients received average daily hydrocortisone doses of 12.0 ± 2.7 mg/m(2) (range, 4.9-19.1) and 15.5 ± 7.8 mg/m(2) (range, 5.7-33.7), respectively. BMD varied within the normal reference range (-2 to +2) in both cohorts. However, lower Z-scores for femoral neck and Ward's region were found in CAH compared to PAI women, but not in men. Prednisolone treatment showed significant lower osteocalcin levels and lower Z-scores for lumbar spine and femoral neck compared to PAI patients on hydrocortisone. PAI women treated with DHEA had significantly lower urinary collagen crosslinks and bone alkaline phosphatase, and significantly higher Z-scores in lumbar spine and femoral Ward's region compared to non-DHEA-treated women.
Adult PAI and CAH patients on low glucocorticoid doses showed normal BMD within the normal reference range. The use of longer acting prednisolone resulted in significantly lower BMD in PAI. In addition, DHEA treatment may have a beneficial effect on bone in Addison's women.
原发性肾上腺功能不全（PAI）和先天性肾上腺增生症（CAH）患者接受糖皮质激素替代治疗，这可能导致骨质疏松症。
本研究旨在探讨以下问题：1）与先前报道相比，较低剂量的糖皮质激素是否会导致 PAI 和 CAH 患者的骨密度（BMD）降低？2）PAI 患者的 BMD 是否受所使用的糖皮质激素类型的影响？3）DHEA 治疗是否会影响 PAI 女性的 BMD？
我们进行了一项前瞻性、横断面研究，纳入 81 例 PAI 患者和 41 例 CAH 患者。
采用双能 X 线吸收法测量 BMD。检测血清骨转换标志物、矿物质、维生素、激素和尿交联水平。
PAI 和 CAH 患者接受的平均日剂量分别为 12.0±2.7mg/m²（范围 4.9-19.1）和 15.5±7.8mg/m²（范围 5.7-33.7）。两组患者的 BMD 均在正常参考范围内（-2 至+2）。然而，与 PAI 女性相比，CAH 女性的股骨颈和 Ward 区 Z 评分较低，但男性则不然。与 PAI 患者接受氢化可的松治疗相比，接受泼尼松龙治疗的患者的骨钙素水平显著降低，腰椎和股骨颈 Z 评分也较低。与未接受 DHEA 治疗的女性相比，接受 DHEA 治疗的 PAI 女性的尿胶原交联和骨碱性磷酸酶水平显著降低，腰椎和股骨 Ward 区的 Z 评分显著升高。
接受低剂量糖皮质激素治疗的成年 PAI 和 CAH 患者的 BMD 处于正常参考范围内。长效泼尼松龙的使用会导致 PAI 患者的 BMD 显著降低。此外，DHEA 治疗可能对肾上腺功能减退症女性的骨骼有有益作用。
