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BMD results after GH therapy not better in hypopituitary patients
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In patients with hypopituitarism, a 2-year regimen of growth hormone therapy does not confer greater benefits in bone mineral density upon those receiving glucocorticoid therapy, according to recent study findings.
Glucocorticoid excess, whether endogenous or related to administration of a drug, has been linked to decreased BMD. Therefore, the researchers sought to determine whether patients on a glucocorticoid-replacement regimen would derive greater benefits from GH replacements than glucocorticoid-sufficient patients.
The researchers evaluated data from an open, prospective longitudinal study of 175 patients diagnosed with hypopituitarism due to non-functioning pituitary adenoma. The study population consisted of 64 women and 111 men with a mean age of 55.5 years. All patients had GH deficiency, and 98 were glucocorticoid insufficient. The glucocorticoid-insufficient patients were on a daily regimen of cortisone acetate or hydrocortisone.
The researchers used DXA to measure BMD before and after the 2-year GH regimen.
At follow-up, they found that there were improvements in BMD and T-scores in the lumbar spine of both glucocorticoid-sufficient and glucocorticoid-insufficient patients, although only glucocorticoid-sufficient patients showed BMD improvement in the femur neck.
After adjustment for weight, age, sex, free thyroxine levels, change in insulin-like growth factor I levels and sex hormone therapy, an independent link between glucocorticoid sufficiency and greater BMD improvements at the femur neck was revealed. No such association was found between glucocorticoid sufficiency and lumbar spine.
The researchers said these findings ran counter to their hypothesis that glucocorticoid-insufficient patients would achieve greater benefits in BMD when treated with GH.
“In contrast to our hypothesis, [glucocorticoid] dependency was not associated with greater response to GH therapy,” the researchers wrote. “In fact, the increase in BMD at femur neck was significantly greater in [glucocorticoid] sufficient patients.”
Disclosure: One researcher reports beings a consultant for AstraZeneca and ViroPharma, and has received lecture fees from Eli Lilly, Merck Serono, Novo Nordisk, Otsuka and Pfizer.
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