title: Long-term corticosteroid replacement and bone mineral density in adult women with classical congenital adrenal hyperplasia.
abstract: BACKGROUND
  Concern has been raised regarding the potential impact of chronic glucocorticoid therapy on the bone mineral density (BMD) of patients with congenital adrenal hyperplasia (CAH).
  
  
  OBJECTIVE
  The purpose of this investigation was to assess the impact of chronic glucocorticoid replacement in adult women with classical CAH.
  
  
  METHODS
  We used dual energy x-ray absorptiometry to evaluate lumbar spine and whole body BMD in 11 women with salt-losing (SL) CAH and 15 with the simple virilizing form. Physical characteristics and serum hormone concentrations were also measured. Results were compared with those of unaffected sisters of CAH patients (n = 9).
  
  
  METHODS
  BMD was the main outcome measure.
  
  
  RESULTS
  Osteopenia was noted in 45% of SL CAH patients, 13% of patients with the simple virilizing form, and 11% of controls. Lumbar spine and whole body BMDs of CAH subjects were lower than those of controls (P < 0.05). Compared with CAH subjects with normal BMD, those with osteopenia had reduced serum levels of dehydroepiandrosterone sulfate and dehydroepiandrosterone. Adrenal androgen levels were particularly suppressed among postmenopausal women receiving glucocorticoid replacement.
  
  
  CONCLUSIONS
  Adult women with classical CAH treated with long-term glucocorticoids are at risk for decreased BMD, especially those with the SL form. Oversuppression of adrenal androgens is associated with increased risk for bone loss in this population.
authors.affiliation: Division of Reproductive Endocrinology, Department of Gynecology and Obstetrics, Johns Hopkins School of Medicine, Baltimore, Maryland 21287, USA. jking8@mac.com
authors.forename: Jeremy A
authors.initials: JA
authors.lastname: King
authors.forename: Amy B
authors.initials: AB
authors.lastname: Wisniewski
authors.forename: Brandon J
authors.initials: BJ
authors.lastname: Bankowski
authors.forename: Kathryn A
authors.initials: KA
authors.lastname: Carson
authors.forename: Howard A
authors.initials: HA
authors.lastname: Zacur
authors.forename: Claude J
authors.initials: CJ
authors.lastname: Migeon
mesh_terms: D015502:Absorptiometry, Photon; D000305:Adrenal Cortex Hormones / Q000627:therapeutic use*; D000312:Adrenal Hyperplasia, Congenital / Q000188:drug therapy* / Q000503:physiopathology*; D000328:Adult; D000728:Androgens / Q000097:blood; D015519:Bone Density / Q000502:physiology*; D005260:Female; D006801:Humans; D008875:Middle Aged; D017698:Postmenopause; D013131:Spine / Q000000981:diagnostic imaging
chemical_list: D000305:Adrenal Cortex Hormones; D000728:Androgens