title: Bone mineral density in girls with classical congenital adrenal hyperplasia due to CYP21 deficiency.
abstract: OBJECTIVE
  To verify possible associations among glucocorticoid doses, use of dexamethasone, and bone mineral density (BMD), measured by dual X-ray absorptiometry (DXA) and quantitative computed tomography (QCT), in female children with congenital adrenal hyperplasia due to CYP21 deficiency (CAH-CYP21). Classical CAH-CYP21 in females allows the study of the effects of hyperandrogenism and chronic glucocorticoid exposure.
  
  
  METHODS
  Cross-sectional observational study.
  
  
  METHODS
  Sixteen girls (4-19 years) with CAH-CYP21 and 32 age-matched control girls.
  
  
  METHODS
  BMD was the main outcome measure assessed by total body and lumbar spine L1-L4 DXA (DXAtot and DXAIs), lumbar spine L1-L4 bone mineral apparent density (BMAD) and spinal L1-L4 QCT of trabecular (QCTtrab) and cortical (QCTcort) bone. The glucocorticoid dose used by patients with CAH-CYP21 was expressed as hydrocortisone equivalents/m2.
  
  
  RESULTS
  Mean BMD in both groups was similar by any method. In patients, BMD decreased with the increasing mean dose of glucocorticoid, seen in QCTcort (r = -0.55; p = 0.03) and QCTtrab (r = -0.52; p = 0.04). There was also a negative correlation between cumulative glucocorticoid dose and BMD in QCTcort (beta = -0.0016; p = 0.005) and QCTtrab (beta = -0.0009; p = 0.03).
  
  
  CONCLUSIONS
  The dose of glucocorticoid used in the treatment of girls with CAH-CYP21 correlated negatively with BMD, and dexamethasone was not selectively harmful.
authors.affiliation: Hospital de Clinicas de Porto Alegre, Endocrinology Section, Porto Alegre, Brasil. rhelnecave@gmail.com
authors.forename: Regina Helena
authors.initials: RH
authors.lastname: Elnecave
authors.forename: Cristiane
authors.initials: C
authors.lastname: Kopacek
authors.forename: Marilia
authors.initials: M
authors.lastname: Rigatto
authors.forename: Juliana
authors.initials: J
authors.lastname: Keller Brenner
authors.forename: José Augusto
authors.initials: JA
authors.lastname: Sisson de Castro
mesh_terms: D015502:Absorptiometry, Photon; D000293:Adolescent; D000312:Adrenal Hyperplasia, Congenital / Q000188:drug therapy / Q000235:genetics* / Q000503:physiopathology*; D015992:Body Mass Index; D015519:Bone Density / Q000187:drug effects / Q000502:physiology*; D016022:Case-Control Studies; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D003907:Dexamethasone / Q000494:pharmacology / Q000627:therapeutic use; D004305:Dose-Response Relationship, Drug; D005260:Female; D005938:Glucocorticoids / Q000494:pharmacology / Q000627:therapeutic use; D006801:Humans; D017588:Hyperandrogenism / Q000503:physiopathology; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging / Q000503:physiopathology; D013255:Steroid 21-Hydroxylase / Q000235:genetics*; D014057:Tomography, X-Ray Computed; D055815:Young Adult
chemical_list: D005938:Glucocorticoids; D003907:Dexamethasone; C531510:CYP21A2 protein, human; D013255:Steroid 21-Hydroxylase