Endocrine Abstracts

Introduction: Patients with primary adrenal insufficiency (PAI) and patients with congenital adrenal hyperplasia (CAH) receive glucocorticoid replacement therapy, which might cause osteoporosis.

Objective: i) Is bone mineral density (BMD) depending on the height of the daily glucocorticoid dose? ii) Is BMD decreasing over a 2-year period of glucocorticoid replacement therapy?

Methods: Prospective, longitudinal study including 56 patients with PAI (41 women) and 32 patients with CAH (21 women). BMD was measured by DXA scan.

Results: Patients with PAI (age 53.3±14.2 years) showed no changes in BMI (26.2±4.2 vs 26.3±4.3 kg/m²) or daily glucocorticoid dose per body surface (13.9±3.9 vs 13.8±4.6 mg/m²) after 28.7±5.8 months. No significant changes in BMD Z-scores of lumbar or femoral regions were detected during the study period. However, daily glucocorticoid dose per body surface significantly negatively correlated with Z-scores of femoral neck (R=−0.317, P=0.021), Ward’s triangle (R=−0.333, P=0.015), greater trochanter (R=−0.390, P=0.004), and total hip (R=−0.340, P=0.014), but not with lumbar regions.

Patients with CAH (age 39.5±11.6y) showed no changes in BMI (26.5±5.3 vs 26.7±5.3 kg/m²) after 28.6±5.0 months, but the daily glucocorticoid dose per body surface decreased significantly (16.2±7.7 vs 13.4±6.8 mg/m², P=0.036). Despite glucocorticoid dose reduction BMD Z-scores of lumbar or femoral regions did not change significantly. In CAH patients no correlation was seen between BMD and daily glucocorticoid dose per body surface.

Conclusions: Adult PAI and CAH patients on low glucocorticoid doses showed normal BMD within the normal reference range, which did not change significantly after 2 years. BMD of the femoral region significantly negatively correlated with daily glucocorticoid dose per body surface in PAI, but not in CAH patients.