Endocrine Abstracts

The treatment of growth hormone deficiency (GHD) with growth hormone (GH) leads to increased bone turnover, new bone formations and increased bone mineral density (BMD). This response is paralleled by an increased demand for bone substrate. We present a case in which the increased turnover induced by GH treatment revealed previously occult metabolic bone disease.

The patient a 56-year-old male with panhypopituitarism following treatment for acromegaly, commenced treatment with GH for typical signs and symptoms of GHD. BMD analysis had revealed severe osteoporosis at lumbar spine and hip. Markers of bone turnover were normal at baseline. After 11 months of treatment the patient developed symptoms and signs of proximal myopathy. Serum calcium, phosphate and vitamin D were reduced; alkaline phosphatase and parathyroid hormone were elevated. Data were consistent with vitamin D deficiency and osteomalacia. Treatment with vitamin D analogues resolved symptoms gradually.

This case demonstrates the anabolic effects of GH on bone and the potential of the increased bone turnover produced by GH treatment to unmask previously occult vitamin d deficiency.