Bone mineral density in girls with classical congenital adrenal hyperplasia due to CYP21 deficiency.

AIM: To verify possible associations among glucocorticoid doses, use of dexamethasone, and bone mineral density (BMD), measured by dual X-ray absorptiometry (DXA) and quantitative computed tomography (QCT), in female children with congenital adrenal hyperplasia due to CYP21 deficiency (CAH-CYP21). Classical CAH-CYP21 in females allows the study of the effects of hyperandrogenism and chronic glucocorticoid exposure. DESIGN: Cross-sectional observational study. PATIENTS: Sixteen girls (4-19 years) with CAH-CYP21 and 32 age-matched control girls. MEASUREMENTS: BMD was the main outcome measure assessed by total body and lumbar spine L1-L4 DXA (DXAtot and DXAIs), lumbar spine L1-L4 bone mineral apparent density (BMAD) and spinal L1-L4 QCT of trabecular (QCTtrab) and cortical (QCTcort) bone. The glucocorticoid dose used by patients with CAH-CYP21 was expressed as hydrocortisone equivalents/m2. RESULTS: Mean BMD in both groups was similar by any method. In patients, BMD decreased with the increasing mean dose of glucocorticoid, seen in QCTcort (r = -0.55; p = 0.03) and QCTtrab (r = -0.52; p = 0.04). There was also a negative correlation between cumulative glucocorticoid dose and BMD in QCTcort (beta = -0.0016; p = 0.005) and QCTtrab (beta = -0.0009; p = 0.03). CONCLUSIONS: The dose of glucocorticoid used in the treatment of girls with CAH-CYP21 correlated negatively with BMD, and dexamethasone was not selectively harmful.

Estimation of truncal adiposity using waist circumference or the sum of trunk skinfolds: a pilot study for insulin resistance screening in hirsute patients with or without polycystic ovary syndrome.

Insulin resistance (IR) is an independent risk factor for cardiovascular disease and is a prevalent metabolic disturbance among women with polycystic ovary syndrome (PCOS). Central adiposity, a marker of IR and an accurate anthropometric method to estimate truncal adiposity, may represent a key clinical tool for IR screening in subpopulations at higher metabolic and cardiovascular risk, such as women with PCOS. The aims of the present study were (1) to investigate the influence of androgens on IR and central obesity in overweight or obese hirsute women with or without PCOS and (2) to test the reliability of the sum of trunk skinfolds (subscapular, suprailiac, and abdominal) to estimate truncal adiposity. This observational, cross-sectional study included 37 hirsute patients with body mass index of 25 kg/m(2) or greater and aged between 14 and 41 years. Twenty-four had PCOS, and 13 had ovulatory cycles, normal androgen levels, and isolated hirsutism, named idiopathic hirsutism (IH). Nutritional, anthropometric, clinical, and laboratory evaluations were performed. Body composition was assessed by measurement of waist circumference and skinfold thickness and by dual-energy x-ray absorptiometry (DXA). Both groups presented similar ages, body mass index, and hirsutism score. The PCOS group had higher androgen levels, homeostasis model assessment (HOMA) index, and fasting insulin levels. Free androgen index was positively associated with HOMA, independent of truncal adiposity (r = 0.441, P = .009). Strong correlations were also observed between truncal adiposity measured by DXA and both the sum of trunk skinfolds (r = 0.863, P = .0001) and waist circumference in hirsute patients (r = 0.947, P = .0001). In our study, IR (HOMA index >/=3.8) was associated with truncal obesity, with a more androgenic profile, and with an unfavorable lipid profile. In conclusion, hirsutism per se appears not to be a risk for IR and related cardiovascular disease unless there is presence of central adiposity and/or abnormal androgen profile as observed in patients with PCOS. Waist circumference and the sum of trunk skinfolds represent accurate methods to estimate truncal adiposity, but waist circumference measurement seems to be the simplest method of clinical screening for IR in hirsute women.