Cross genotype sex hormone treatment in two cases of hypogonadal osteoporosis.
BACKGROUND
Sex hormone deficiency is the most common cause of bone loss. Reduced bone mass and an increased risk for osteoporotic fractures have been described in hypogonadal subjects of both sexes. We present here the results of treating two patients showing abnormal sexual differentiation (an XX male and an XY female), who suffered from bone loss related to sex hormone deficiency, with cross genotype sex hormones.


METHODS
Patient 1 was an asymptomatic 39-yr-old XY female with complete androgen insensitivity. Her testes had been removed, and she later discontinued estrogen treatment. Patient 2, a 37-yr-old XX male, had congenital adrenal hyperplasia, which led to a masculine phenotype. He was ovariectomized and reared as a male. He was treated with glucocorticoids but refused androgen treatment for many years. We treated both patients with phenotypically matched sex hormones (patient 1 received conjugated estrogens 1.25 mg/day, and patient 2 received 250 mg testosterone every 4 weeks) and followed their bone mineral density (BMD) using dual-energy X-ray absorptiometry, urine calcium, and hydroxyproline excretion.


RESULTS
Before treatment both patients had low sex hormones and highly elevated gonadotropins. As a result of treatment urine hydroxyproline excretion decreased from 45 and 26.7 mg/g creatinine to 15 and 15.9 mg/g creatinine in patients 1 and 2 respectively. In patient 1, lumbar BMD rose from 0.912gr/cm2 to 0.976gr/cm2 and femoral neck BMD rose from 0.716gr/cm2 to 0.836gr/cm2 after 4 years of treatment. In patient 2, lumbar BMD rose from 0.717gr/cm2 to 0.815gr/cm2 and the femoral neck BMD rose from 0.509gr/cm2 to 0.635gr/cm2 after 27 months of treatment.


CONCLUSIONS
Phenotypically-matched sex hormone therapy in patients with abnormal sexual differentiation is essential not only to maintain external appearance but also for the preservation of bone mass.
Vered
I
I
Pediatric Endocrinology Unit, Chaim Sheba Medical Center, Tel Hashomer, Israel.
Kaiserman
I
I
Sela
B A
BA
Sack
J
J
D000328:Adult; D015519:Bone Density; D004967:Estrogens / Q000627:therapeutic use*; D005260:Female; D005838:Genotype; D006801:Humans; D006909:Hydroxyproline / Q000652:urine; D007006:Hypogonadism / Q000150:complications / Q000188:drug therapy* / Q000235:genetics*; D008297:Male; D010024:Osteoporosis / Q000188:drug therapy* / Q000209:etiology / Q000235:genetics*; D013739:Testosterone / Q000627:therapeutic use*; D016896:Treatment Outcome
D004967:Estrogens; D013739:Testosterone; D006909:Hydroxyproline