Gonadotropin-Releasing Hormone Agonist Therapy and Longitudinal Bone Mineral Density in Congenital Adrenal Hyperplasia.

Autor:	Flokas ME; Children's National Hospital, Washington, DC 20010, USA.; The Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD 20892-1932, USA., Wakim P; The National Institutes of Health Clinical Center, Bethesda, MD 20892-1932, USA., Kollender S; The National Institutes of Health Clinical Center, Bethesda, MD 20892-1932, USA., Sinaii N; The National Institutes of Health Clinical Center, Bethesda, MD 20892-1932, USA., Merke DP; The Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD 20892-1932, USA.; The National Institutes of Health Clinical Center, Bethesda, MD 20892-1932, USA.
Jazyk:	angličtina
Zdroj:	The Journal of clinical endocrinology and metabolism [J Clin Endocrinol Metab] 2024 Jan 18; Vol. 109 (2), pp. 498-504.
DOI:	10.1210/clinem/dgad514
Abstrakt:	Context: Children with congenital adrenal hyperplasia (CAH) are at risk for early puberty. Gonadotropin-releasing hormone analog (GnRHa) is frequently used and can decrease bone mineral density (BMD). Objective: Our aim was to investigate the effect of GnRHa therapy on BMD in a longitudinal study of patients with CAH spanning both childhood and adulthood. Design and Setting: Sixty-one patients with classic CAH due to 21-hydroxylase deficiency (20 treated with GnRHa) were followed with dual-energy X-ray absorptiometry (DXA) scans at puberty onset, attainment of adult height, and during early adulthood. Main Outcome Measures: Whole body, lumbar spine, femoral neck, total hip, and distal radius BMD z-score at adult height. Longitudinal BMD and adult height were also assessed. Results: Twenty patients received GnRHa for an average of 4.5 ± 2 years. There were no differences in BMD between GnRHa-treated and -untreated groups at adult height for all sites. Overall, the follow-up DXA during early adulthood showed decreases in BMD z-scores for whole body (P = .01), lumbar spine (P < .0001), femoral neck (P = .06), total hip (P = .009), and distal radius (P = .05). GnRHa treatment correlated with improved height outcomes compared to predicted height at puberty onset after adjusting for midparental height (P = .02). Patients in both groups achieved similar adult height. Conclusion: In children with CAH, GnRHa does not compromise BMD. However, BMD decreases with time and during the second and third decades of life is a possible effect of chronic supraphysiologic glucocorticoids. Children with CAH who experience early puberty benefit from GnRHa treatment as evidenced by the positive effect on height. (Published by Oxford University Press on behalf of the Endocrine Society 2023.)
Databáze:	MEDLINE
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