ISSN 1470-3947 (print) | ISSN 1479-6848 (online)

Endocrine Abstracts (2008) 16 P18

Impact of total cumulative glucocorticoid dose on bone mineral density in patients with 21-hydroxylase deficiency

Chakhtoura Zeina1, Bachelot Anne1, Samara-Boustani Dinane2, Ruiz Jean-Charles1, Donadille Bruno3, Dulon Jérome1, Christin-Maitre Sophie3, Bouvattier Claire4, Raux-Demay Marie-Charles5, Bouchard Philippe3, Carel Jean-Claude6, Leger Juliane6, Kuttenn Frédérique1, Polak Michel2 & Touraine Philippe1

1Pitié-Salpétrière Hospital, Paris, France; 2Necker Hospital, Paris, France; 3Saint Antoine Hospital, Paris, France; 4Saint-Vincent de Paul Hospital, Paris, France; 5Trousseau Hospital, Paris, France; 6Robert-Debré Hospital, Paris, France.

Introduction: There are contradictory results concerning bone mineral density status in adult patients with congenital adrenal hyperplasia. To resolve this issue, we hypothesized that there could be a correlation between BMD and a total cumulative glucocorticoid dose from the diagnosis in early infancy to adulthood. We then conducted a retrospective in a referral centers for CAH. Thirty-eight adult patients (28 women, 10 men, aged 16–39 years) suffering from CAH and treated since early infancy (24 with the salt-wasting form, 5 with the simple virilizing form and 9 with the non-classical form) were included in the study. BMD was measured in the lumbar spine and femoral neck. Total cumulative dose (TCG) and total average (TAG) glucocorticoid dose were calculated from pediatric and adult files.

Results: CAH patients showed a significant difference between final height and target height (−0.82±0.92 S.D. for women and −1.31±0.84 S.D. for men; P<0.001). There was a discrepancy between the 28 women and the 10 men for lumbar T-score (−0.26±0.23 S.D. versus −1.25±0.42 S.D.; P=0.04) and femoral T-score (0.21±0.25 S.D. versus −1.08±0.35 S.D.; P=0.009). Non-classical women had higher lumbar T-score (0.33±0.46 S.D. versus −0.36±0.23 S.D.; P=0.003) and femoral T-score (0.62±0.43 S.D. versus 0.20±0.32 S.D.; P=0.01) than salt-wasting women. There was a strong correlation between BMI and femoral BMD in patients (R=0.67; P<0.001). We found negative correlations between TCG, TAG and lumbar (R=−0.38; P=0.02 and R=−0.50; P=0.001, respectively) and femoral T-scores (R=−0.43; P=0.006 and R=−0.51; P<0.001, respectively).

Conclusion: Adult CAH patients, especially men, have lower BMD and this was correlated with TCG. These results should help us in improving the management and the follow-up of BMD in CAH patients from childhood to adulthood.