Glucocorticoid replacement therapy and vertebral fractures in hypopituitary adult males with GH deficiency
Gherardo Mazziotti1, Teresa Porcelli1, Antonio Bianchi2, Vincenzo Cimino2, Carola Mejia1, Ilaria Patelli1, Alessandra Fusco2, Antonella Giampietro2, Laura De Marinis2 & Andrea Giustina1
GH deficiency (GHD) and excess of glucocorticoids are associated with increased risk of fragility fractures. Most adult GHD patients have other pituitary deficiencies, but it is unclear whether these deficiencies or their overreplacement therapies may influence the bone disease occurring in GHD. The aim of this study was to evaluate whether the prevalence of vertebral fractures may be influenced by glucocorticoid replacement therapy in hypopituitary males with GHD. We studied 58 adult hypopituitary patients (all males; mean age 49 years, range: 2281) with severe GHD (replaced in 22 patients, untreated in 36 patients). Fifty-two patients (89.6%) had also glucocorticoid deficiency and all of them were replaced with cortisone or hydrocortisone. All patients were evaluated for bone mineral density (BMD) by lumbar DXA and for vertebral fractures by a radiological and morphometric approach. The patients gave informed consent to the study that was approved by local ethical committee. Vertebral fractures were observed in 35 patients (60.3%) without significant correlation with BMD. Fractured patients received higher daily doses of cortisone acetate or equivalent (36.0 mg, range: 12.575 vs 25.0 mg, range: 12.550.0; P=0.02) and had higher urinary cortisol values (83 μg/24 h, range: 24135 vs 69 μg/24 h, range: 21133; P=0.05) than patients who did not fracture. In untreated GHD, vertebral fractures occurred more frequently in patients with high urinary cortisol values (3rd tertile) as compared with patients with low urinary cortisol values (1st tertile) (92.3 vs 50.0%; P=0.03) regardless of BMD. In treated GHD, by contrast, the prevalence of vertebral fractures was significantly lower as compared with untreated GHD and it was not influenced by urinary cortisol values. Glucocorticoid replacement therapy may increase the prevalence of vertebral fractures in patients with untreated GHD. However, GH treatment in GHD seems to protect the skeleton from the deleterious effects of glucocorticoid overtreatment.