title: Glucocorticoid replacement therapy is independently associated with reduced bone mineral density in women with hypopituitarism.
abstract: OBJECTIVE
  Patients with hypopituitarism have adverse cardiovascular morbidity and reduced bone mineral density (BMD). The objective of this study was to analyse the effects of glucocorticoid (GC) replacement on cardiovascular risk factors and BMD in patients with hypopituitarism.
  
  
  METHODS
  This was a cross-sectional study on 365 patients with hypopituitarism. Two-hundred and four patients (56%) were ACTH insufficient (ACTHins), receiving a mean ± SD hydrocortisone equivalent (HCeq) dose of 20·5 ± 5·8 mg/day. The difference in BMD and cardiovascular risk profile between ACTH sufficient (ACTHsuff) and ACTHins patients, before commencement of GH replacement, was analysed by multiple linear and logistic regression.
  
  
  RESULTS
  ACTHins was independently associated with lower fasting glucose but not other cardiovascular risk factors. The mean HCeq dose per kg body weight was 15% higher in ACTHins women than in ACTHins men (P = 0·009). In women, ACTHins was independently associated with decreased BMD at the lumbar spine (P = 0·002) and femoral neck (P = 0·006) and the presence of osteopenia (P = 0·004). BMD was not different between ACTHins and ACTHsuff men.
  
  
  CONCLUSIONS
  The current average HCeq dose of approximately 20 mg per day is not associated with an adverse metabolic profile, as compared with ACTHsuff patients with hypopituitarism. GC replacement in ACTHins women is independently associated with reduced BMD and higher prevalence of osteopenia.
authors.affiliation: Department of Endocrinology, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg and Sahlgrenska University Hospital, Göteborg, Sweden. oskar.ragnarsson@medic.gu.se
authors.forename: Oskar
authors.initials: O
authors.lastname: Ragnarsson
authors.forename: Helena Filipsson
authors.initials: HF
authors.lastname: Nyström
authors.forename: Gudmundur
authors.initials: G
authors.lastname: Johannsson
mesh_terms: D000328:Adult; D000368:Aged; D015519:Bone Density / Q000187:drug effects*; D001851:Bone Diseases, Metabolic / Q000139:chemically induced; D002318:Cardiovascular Diseases / Q000209:etiology; D003430:Cross-Sectional Studies; D005260:Female; D020249:Hormone Replacement Therapy / Q000009:adverse effects*; D006801:Humans; D006854:Hydrocortisone / Q000009:adverse effects*; D007018:Hypopituitarism / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D012727:Sex Characteristics
chemical_list: D006854:Hydrocortisone