title: Sexual difference in bone geometry of adult patients with classical congenital adrenal hyperplasia: data using peripheral quantitative computed tomography.
abstract: OBJECTIVE
  Glucocorticoid treatment may influence bone and muscle development in patients with congenital adrenal hyperplasia (CAH). This study evaluated bone mineral density (BMD), bone geometry and muscle mass.
  
  
  METHODS
  73 adult patients with classical CAH were followed. BMD, bone geometry and muscle mass were measured using peripheral quantitative computed tomography (pQCT). Glucocorticoid-equivalent doses throughout life were calculated and at the time pQCT androgen levels were measured.
  
  
  RESULTS
  In males the mean standard deviation (SD) score for trabecular BMD (-0.33 ± 0.71) was reduced, whereas mean cortical BMD (1.05 ± 1.11) was elevated. Mean total (0.86 ± 1.12) and medullary cross-sectional area (CSA; 1.12 ± 1.17) were significantly increased (p < 0.001). In all patients SD scores for cortical thickness (-0.65 ± 0.91) and muscle CSA (-0.83 ± 0.91) were reduced. Treatment duration was associated with lower trabecular BMD in males (r = -0.63, p < 0.001). Suppressed androgens and simple virilizing CAH had an adverse effect on the muscle CSA SD score (OR 0.58 and 0.46, respectively, p < 0.05).
  
  
  CONCLUSIONS
  There was a sexual difference with enlarged total and medullary CSA in females, whereas in males trabecular BMD was reduced and cortical BMD elevated. Cortical thickness and muscle CSA were reduced in all CAH patients with a possible long-term impact on bone development and stability. Monitoring of bone and muscle development might be warranted.
authors.affiliation: Division of Endocrinology and Diabetology, University Children's Hospital, Ludwig Maximilians University, Munich, Germany.
authors.forename: Susanne
authors.initials: S
authors.lastname: Bechtold
authors.forename: Andreas
authors.initials: A
authors.lastname: Beyerlein
authors.forename: Walter
authors.initials: W
authors.lastname: Bonfig
authors.forename: Robert
authors.initials: R
authors.lastname: Dalla Pozza
authors.forename: Stephanie
authors.initials: S
authors.lastname: Putzker
authors.forename: Ragna
authors.initials: R
authors.lastname: Otto
authors.forename: Heinrich
authors.initials: H
authors.lastname: Schmidt
authors.forename: Hans Peter
authors.initials: HP
authors.lastname: Schwarz
mesh_terms: D000293:Adolescent; D000312:Adrenal Hyperplasia, Congenital / Q000473:pathology*; D000328:Adult; D000886:Anthropometry; D015519:Bone Density; D001842:Bone and Bones / Q000473:pathology*; D015331:Cohort Studies; D005260:Female; D006728:Hormones / Q000097:blood; D006801:Humans; D008297:Male; D009929:Organ Size; D012727:Sex Characteristics; D013255:Steroid 21-Hydroxylase / Q000235:genetics; D014057:Tomography, X-Ray Computed; D055815:Young Adult
chemical_list: D006728:Hormones; D013255:Steroid 21-Hydroxylase