Glucocorticoid replacement therapy and vertebral fractures in hypopituitary adult males with GH deficiency

G Mazziotti, Teresa Porcelli, Antonio Bianchi, V Cimino, I Patelli, C Mejia, Alessandra Fusco, Antonella Giampietro, Laura De Marinis Grasso, A. Giustina

Risultato della ricerca: Contributo in rivistaArticolo in rivista

52 Citazioni (Scopus)


Objective: GH deficiency (GHD) and glucocorticoid excess are associated with increased risk of fragility fractures. We aimed to evaluate whether the prevalence of vertebral fractures may be influenced by glucocorticoid over-replacement in hypopituitary males with GHD. Design: Cross-sectional study. Methods: Fifty-one adult hypopituitary patients (all males; mean age 55 years, range: 23-81) with severe adult-onset GHD (replaced in 21 patients and untreated in 30 patients) and glucocorticoid deficiency on replacement treatment were studied for vertebral fractures using a radiological and morphometric approach. Results: Vertebral fractures were observed in 31 patients (60.8%) in correlation with untreated GHD, urinary cortisol values, and cortisone doses. Patients were stratified according to treatment of GHD, and current and cumulative cortisone doses. In untreated GHD, vertebral fractures occurred more frequently in patients who had received higher (greater than median) cumulative and current doses of cortisone compared with patients who had received lower (less than median) drug doses (95.2 vs 50.0%, P=0.009 and 90.5 vs 55.6%, P=0.04 respectively). In untreated GHD, fractured patients had significantly higher urinary cortisol values compared with patients without vertebral fractures (84 μg/24 h, range: 24-135 vs 49 μg/24 h, range: 30-96; P=0.04). In treated GHD patients, by contrast, the prevalence of vertebral fractures was not influenced by cumulative and current cortisone doses and urinary cortisol values. Conclusions: Glucocorticoid over-replacement may increase the prevalence of vertebral fractures in patients with untreated GHD. However, treatment of GHD seems to protect the skeleton from the deleterious effects of glucocorticoid overtreatment in hypopituitary patients. © 2010 European Society of Endocrinology.
Lingua originaleEnglish
pagine (da-a)15-20
Numero di pagine6
RivistaEuropean Journal of Endocrinology
Stato di pubblicazionePubblicato - 2010


  • Aged
  • Aged, 80 and over
  • Glucocorticoids
  • Hormone Replacement Therapy
  • Human Growth Hormone
  • Humans
  • Hydrocortisone
  • Logistic Models
  • Male
  • Middle Aged
  • Spinal Fractures
  • Testosterone
  • Young Adult
  • aged
  • article
  • bone density
  • controlled study
  • corticosteroid induced osteoporosis
  • cortisone
  • cross-sectional study
  • dual energy X ray absorptiometry
  • glucocorticoid
  • growth hormone
  • growth hormone deficiency
  • human
  • hydrocortisone urine level
  • hypogonadism
  • hypopituitarism
  • hypothyroidism
  • major clinical study
  • male
  • priority journal
  • radioimmunoassay
  • testosterone enantate
  • testosterone propionate, adult
  • treatment outcome
  • vertebra fracture, Adult


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