| Objective: To detect effect of current dose of glucocorticoid(GC) replacement therapy on the bone mineral density in adrenal insufficiency(AI) patients.Methods: A thorough search of the literatures(O vid Medline, EMBASE and Pub med) was performed. Relevant studies were divided and analyzed according to their primary disease, subgroup analysis according to different dose of hydrocortisone and different population.Results: There were 27 articles included in the study. Five articles were about primary adrenal insufficient(PAI), and 23 articles were about congenital adrenal hyperplasia(CAH), with a total of 1264 patients.After meta-analysis, in PAI patients, the BMD at lumbar spine(LS) declined, the weight mean difference of Z-score and 95% confidence interval(CI) was-0.356[(-0.547)-(-0.164)] and p value was 0.002, and the BMD at the femoral neck(FN) declined too, the weight mean difference of Z-score and 95% CI was-0.228[(-0.316)-(-0.140)] and p value was 0.068, not reached significant difference. In a subgroup analysis, a drop was observed at LS in the group that received equal quantity of hydrocortisone(HCeq)>25mg/day, the weight mean difference of Z-score and 95% CI was-0.504[(-0847)-(-0.161)] and p value was 0.003; on the other hand, in the group that received HCeq<25mg/day, there was no obvious change of the BMD at LS, the weight mean difference of Z-score and 95% CI was-0.054[(-0824)-(0.933)] and p value was 0.045.In CAH patients, a decrease at LS and FN was found in the group that took HCeq>15mg/m2/day, the weight mean difference of Z-score and 95% CI was-0.290[(-0.489)-(-0.092)] and-0.578[(-0.802)-(-0.353)] separately and p value both were 0.00; in the group that received HCeq<25mg/day, no change was found, the weight mean difference of Z-score and 95% CI was 0.107[(-0.390)-0.065]. In further group analysis for the patients who took HCeq>15mg/m2/day, a reduce at LS and FN was just detected in puberty and adolescent, the weight mean difference of Z-score and 95% CI was-0.356[(-0.547)-(-0.164)] and-0.578[(-0.802)-(-0.353)] and p value was 0.013 and 0.00 separately; and in prepuberty patients no change was found.Conclusion: This meta-analysis suggests that current dose of glucocorticoid(GC) induce bone loss in PAI and CAH patients, this may be related to the supraphysiological GC replacement, the dose of hydrocortisone less than 25 mg or 15 mg/m2 every day is more appropriate for the PAI or CAH patients.Objective: To study the bone mineral density(BMD)in second adrenal insufficiency(SAI)patients and to detect the factors that would influence BMD.Methods: In the present study, there is 41 secondary adrenal insufficiency(SAI) patients, their LS and FN BMD, pituitary hormone concentration, [prolactin, follicle-stimulating hormone, luteinizing hormone, thyroid hormone and adrenocorticotropic hormone(ACTH)], free cortical concentration, serum testosterone level, serum estradiol level, vitamin D,free calcium osteocalcin, total N-terminal peptide of type I procollagen and c-terminal cross- linking peptide of type I co1 Iagen level were measured; And an analysis of Pearson correlation between BMD and the related clinical indicators was conducted.Results: For the SAI patients, there is 29 women, they were 48.79 ± 10.97(23-66)years old,the duration was 84.65±91.38 months(1 month to 29 years), the Z score of LS and FN BMD was-1.51±1.35, 95%CI(-2.02,-0.99) and-0.58±1.11, 95%CI(-1.26,0.09) separately, 16 person occurred osteoporosis(55%), and 6 person occurred osteopenia(21%); there is 12 men, they were 51.33±17.98(24-75) years old, the duration was 39.37±46.85 months(1 week to 11years), the Z score of LS and FN BMD was-2.12±1.33, 95%CI(-2.96,-1.27) and-0.32±1.34, 95%CI(-1.28,0.64) separately, 5 person(42%) occurred osteoporosis, and 6 person(50%) occurred osteopenia; 19 patients(46.34%) were treated with prednisone, the period of treatment was 64.8±84.94(1-312)months, the oral HCeq was 22.92±8.84mg/day or 14.94±5.87 mg/m2/day.The present study suggests that SAI and PAI patients' LS and FN BMD were lower than their peers. SAI patients were hypogonadal, serum estrogen and testosterone levels were lower than the lower limitation of reference value; the LS BMD was significantly positively correlated to the weight, BMI, every day dose of hydrocortisone and every day body surface area dose of hydrocortisone, the r coefficient was 0.469, 0.473, 0.556, 0.510 respectively, the FN BMD was significantly positively correlated to the weight and BMI,the r coefficient was 0.499 and 0.513 respectively; LS and FN BMD were not different between giving prednisone treatment patients and non treatment patients.Conclusion: In SAI patients, the LS and FN BMD are lower than their peers, it may be associated with estrogen, testosterone and GH deficiency for a long time, in addition, the body weight and body fat also has an effect on BMD; and on the premise of no more than physiological GC dose, increase the dose of hydrocortisone is beneficial to the bone health. |
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