[Estimation of influence of congenital-adrenal hyperplasia treatment on bone mineralisation evaluated with densitometry]. / Ocena wplywu leczenia pacjentów z wrodzonym przerostem nadnerczy na mase kostna okreslona badaniem densytometrycznym

INTRODUCTION: Doses of glucocorticoids used when treating congenital adrenal hyperplasia (CAH) are larger than physiological secretion of hydrocortisone in healthy people. Optimal dosage should provide metabolic control and should not cause complications of steroid therapy. AIM OF THE STUDY: 1. Evaluation of the influence of CAH treatment on bone mineralisation established with densitometry. 2. Evaluation of steroid profiles usage, in estimation of bone mineralisation disorders risk in patients with CAH. MATERIAL AND METHODS: A total number of 28 patients with CAH, aged 2.7-27 years and receiving treatment with glucocorticoids was examined. Therapeutic coefficient and steroidal coefficient which relate to doses of hydrocortisone used were established using urine steroid profiling, which was effectuated by gas chromatography/mass spectrometry (GC/MS). Additionally dual energy x-ray absorptiometry (DXA) of the lumbar spine (L1-L4) was conducted, where bone mineral density (BMD) was established in g/cm(2), and interpreted as Z-score. RESULTS: BMD presented in Z-score, evaluated in correlation to bone age was significantly lower (p <0.01) than BMD presented in Z-score in correlation to chronological age. It was proved that greater hormonal treatment efficacy (lower steroidal coefficient or greater therapeutic coefficient) correlates with greater bone mineralisation deficits in relation to chronological age. CONCLUSIONS: 1. Greater efficiency of hormonal treatment links with larger bone mineralisation deficits in relation to CAH patients' chronological age. 2. Evaluation of steroid profiles, as one of the estimation methods for metabolic control of the disease, described by steroidal coefficient and therapeutic coefficient, allows for practical application of the above mentioned in prediction of bone mineralisation risk in patients with CAH.