Gonadotropin-Releasing Hormone Agonist Therapy and Longitudinal Bone Mineral Density in Congenital Adrenal Hyperplasia
Myrto Eleni Flokas, Paul Wakim, Sarah Kollender, Ninet Sinaii, Deborah P Merke- Biochemistry (medical)
- Clinical Biochemistry
- Endocrinology
- Biochemistry
- Endocrinology, Diabetes and Metabolism
Abstract
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 DXA scans at puberty onset, attainment of adult height, and during early adulthood.
Main outcome measures
Whole body, lumbar spine, femoral neck, total hip, 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 = 0.01), lumbar spine (p < 0.0001), femoral neck (p = 0.06), total hip (p = 0.009), and distal radius (p = 0.05). GnRHa treatment correlated with improved height outcomes compared to predicted height at puberty onset after adjusting for midparental height (p = 0.02). 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, 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.