Glucocorticoid replacement therapy and vertebral fractures in hypopituitary adult males with GH deficiency.
OBJECTIVE
GH deficiency (GHD) and glucocorticoid excess are associated with increased risk of fragility fractures. We aimed to evaluate whether the prevalence of vertebral fractures may be influenced by glucocorticoid over-replacement in hypopituitary males with GHD.


METHODS
Cross-sectional study.


METHODS
Fifty-one adult hypopituitary patients (all males; mean age 55 years, range: 23-81) with severe adult-onset GHD (replaced in 21 patients and untreated in 30 patients) and glucocorticoid deficiency on replacement treatment were studied for vertebral fractures using a radiological and morphometric approach.


RESULTS
Vertebral fractures were observed in 31 patients (60.8%) in correlation with untreated GHD, urinary cortisol values, and cortisone doses. Patients were stratified according to treatment of GHD, and current and cumulative cortisone doses. In untreated GHD, vertebral fractures occurred more frequently in patients who had received higher (greater than median) cumulative and current doses of cortisone compared with patients who had received lower (less than median) drug doses (95.2 vs 50.0%, P=0.009 and 90.5 vs 55.6%, P=0.04 respectively). In untreated GHD, fractured patients had significantly higher urinary cortisol values compared with patients without vertebral fractures (84 microg/24 h, range: 24-135 vs 49 microg/24 h, range: 30-96; P=0.04). In treated GHD patients, by contrast, the prevalence of vertebral fractures was not influenced by cumulative and current cortisone doses and urinary cortisol values.


CONCLUSIONS
Glucocorticoid over-replacement may increase the prevalence of vertebral fractures in patients with untreated GHD. However, treatment of GHD seems to protect the skeleton from the deleterious effects of glucocorticoid overtreatment in hypopituitary patients.
Mazziotti
G
G
Department of Medical and Surgical Sciences, Montichiari Hospital, University of Brescia, Via Ciotti 154, 25018 Montichiari, Italy.
Porcelli
T
T
Bianchi
A
A
Cimino
V
V
Patelli
I
I
Mejia
C
C
Fusco
A
A
Giampietro
A
A
De Marinis
L
L
Giustina
A
A
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005938:Glucocorticoids / Q000009:adverse effects* / Q000627:therapeutic use*; D020249:Hormone Replacement Therapy / Q000379:methods*; D019382:Human Growth Hormone / Q000172:deficiency*; D006801:Humans; D006854:Hydrocortisone / Q000652:urine; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016103:Spinal Fractures / Q000139:chemically induced* / Q000453:epidemiology* / Q000652:urine; D013739:Testosterone / Q000627:therapeutic use; D055815:Young Adult
D005938:Glucocorticoids; D019382:Human Growth Hormone; D013739:Testosterone; D006854:Hydrocortisone