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  • Title: The impact of glucocorticoid replacement on bone mineral density in patients with hypopituitarism before and after 2 years of growth hormone replacement therapy.
    Author: Ragnar Agnarsson H, Johannsson G, Ragnarsson O.
    Journal: J Clin Endocrinol Metab; 2014 Apr; 99(4):1479-85. PubMed ID: 24423362.
    Abstract:
    CONTEXT: Patients with hypopituitarism have reduced bone mineral density (BMD) and increased fracture risk. OBJECTIVE: The aim of this study was to analyze the effects of glucocorticoid (GC) replacement on BMD before and after 2 years of GH therapy in hypopituitary patients. The main hypothesis was that patients on GC replacement demonstrate greater improvement in BMD when treated with GH. DESIGN: This was a post hoc analysis of data from a prospective single-center study. PATIENTS: Data on 175 adult patients with hypopituitarism and verified GH deficiency due to nonfunctioning pituitary adenoma were analyzed. Ninety-eight (56%) were GC insufficient, receiving a mean ± SD hydrocortisone equivalent dose of 20.9 ± 5.0 mg/d. MAIN OUTCOME MEASURE: BMD before and after 2 years of GH replacement therapy was measured by using dual-energy X-ray absorptiometry. RESULTS: BMD at baseline did not differ between GC-sufficient and -insufficient patients, neither at lumbar spine nor femur neck. After 2 years on GH replacement, BMD increased in both groups. After adjustment for weight, age, gender, free T4 concentrations, change in IGF-I levels, and sex hormone treatment, GC sufficiency was associated with a greater increase in BMD at the femur neck (ΔT-score in GC insufficient patients 0.09 ± 0.46, in GC sufficient patients 0.19 ± 0.43; P < .05) but not at the lumbar spine. CONCLUSIONS: GH replacement therapy for 2 years increased BMD in hypopituitary patients. In contrast to our hypothesis, GC-insufficient patients receiving near physiological doses of hydrocortisone do not show a greater therapeutic response to GH therapy than their GC-sufficient counterparts.
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