Abstract
Glucocorticoid therapy in CAH is titrated to maintain adequate adrenal suppression while avoiding the consequences of steroid excess. Although adrenal steroid levels may acutely reflect over-dosage, chronic overtreatment is often suspected only after growth failure and retardation of bone age are noted. Osteoporosis is a known complication of steroid therapy and has been described in CAH. Photon absprbtiometry is a simple, precise and noninvasive method of measuring bone demineralization. It may afford a more sensitive measure of steroid overtreatment than a bone age film, with less radiation exposure. We measured bone density in 20 CAH patients (10 males and 10 females) using the linear radiation model SP-2 bone mineral analyzer and correlated the findings with steroid levels as well as clinical aspects related to glucocorticoid treatment.
Preliminary data show that there is some correlation between bone density and glucocorticoid management of CAH. All the patients with elevated or borderline elevated adrenal steroid levels had bone density values in the normal range. 3 of 5 girls with biochemical values suggesting overdosage had bone density values in the range consistent with demineralization. None of these 3 had any decline in growth velocity and bone ages done in 2 of the 3 showed no delay. These preliminary data suggest that bone densitometry may be of benefit in monitoring therapy in CAH patients and may result in the earlier detection of oversuppression.
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Lee, M., Ackland, F., Dahlem, S. et al. BONE DENSITOMETRY IN CONGENITAL ADRENAL HYPERPLASIA (CAH). Pediatr Res 21 (Suppl 4), 249 (1987). https://doi.org/10.1203/00006450-198704010-00491
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DOI: https://doi.org/10.1203/00006450-198704010-00491