title: [Estimation of influence of congenital-adrenal hyperplasia treatment on bone mineralisation evaluated with densitometry].
abstract: BACKGROUND
  Doses of glucocorticoids used when treating congenital adrenal hyperplasia (CAH) are larger than physiological secretion of hydrocortisone in healthy people. Optimal dosage should provide metabolic control and should not cause complications of steroid therapy.
  
  
  OBJECTIVE
  1. Evaluation of the influence of CAH treatment on bone mineralisation established with densitometry. 2. Evaluation of steroid profiles usage, in estimation of bone mineralisation disorders risk in patients with CAH.
  
  
  METHODS
  A total number of 28 patients with CAH, aged 2.7-27 years and receiving treatment with glucocorticoids was examined. Therapeutic coefficient and steroidal coefficient which relate to doses of hydrocortisone used were established using urine steroid profiling, which was effectuated by gas chromatography/mass spectrometry (GC/MS). Additionally dual energy x-ray absorptiometry (DXA) of the lumbar spine (L1-L4) was conducted, where bone mineral density (BMD) was established in g/cm(2), and interpreted as Z-score.
  
  
  RESULTS
  BMD presented in Z-score, evaluated in correlation to bone age was significantly lower (p <0.01) than BMD presented in Z-score in correlation to chronological age. It was proved that greater hormonal treatment efficacy (lower steroidal coefficient or greater therapeutic coefficient) correlates with greater bone mineralisation deficits in relation to chronological age.
  
  
  CONCLUSIONS
  1. Greater efficiency of hormonal treatment links with larger bone mineralisation deficits in relation to CAH patients' chronological age. 2. Evaluation of steroid profiles, as one of the estimation methods for metabolic control of the disease, described by steroidal coefficient and therapeutic coefficient, allows for practical application of the above mentioned in prediction of bone mineralisation risk in patients with CAH.
authors.affiliation: Klinika Pediatrii, Endokrynologii, Diabetologii, Chorób Metabolicznych i Kardiologii Wieku Rozwojowego Pomorzkiego Uniwersytetu Medycznego w Szczecinie. hanna.romanowska@wp.pl
authors.forename: Hanna
authors.initials: H
authors.lastname: Romanowska
authors.forename: Elżbieta
authors.initials: E
authors.lastname: Krzywińska-Zdeb
authors.forename: Maria
authors.initials: M
authors.lastname: Giżewska
authors.forename: Lilia
authors.initials: L
authors.lastname: Kotkowiak
authors.forename: Krzysztof
authors.initials: K
authors.lastname: Safranow
authors.forename: Anita
authors.initials: A
authors.lastname: Horodnicka-Józwa
authors.forename: Elżbieta
authors.initials: E
authors.lastname: Petriczko
authors.forename: Beata
authors.initials: B
authors.lastname: Krupa
authors.forename: Mieczysław
authors.initials: M
authors.lastname: Walczak
mesh_terms: D015502:Absorptiometry, Photon; D000293:Adolescent; D000312:Adrenal Hyperplasia, Congenital / Q000188:drug therapy* / Q000378:metabolism*; D001823:Body Composition; D015519:Bone Density / Q000187:drug effects*; D016723:Bone Remodeling / Q000187:drug effects*; D001842:Bone and Bones / Q000187:drug effects / Q000378:metabolism*; D002648:Child; D002675:Child, Preschool; D003907:Dexamethasone / Q000627:therapeutic use; D004305:Dose-Response Relationship, Drug; D015536:Down-Regulation / Q000187:drug effects; D005260:Female; D005938:Glucocorticoids / Q000008:administration & dosage*; D006801:Humans; D006854:Hydrocortisone / Q000627:therapeutic use; D008159:Lumbar Vertebrae; D008297:Male; D011044:Poland; D055815:Young Adult
chemical_list: D005938:Glucocorticoids; D003907:Dexamethasone; D006854:Hydrocortisone