Glucocorticoid Therapy in CAH Patients Poses Risk to Male Bone Health

Patients with congenital adrenal hyperplasia (CAH) undergoing glucocorticoid therapy face challenges with bone mineral density (BMD), raising concerns about long-term health outcomes. A recent observational study highlighted that young adult males with CAH, particularly after puberty, experienced a marked decline in BMD, suggesting a risk for secondary osteoporosis. The study focused on a subgroup of 36 young adult patients who had completed pubertal development, comparing their BMD to 51 healthy volunteers.

The study found that BMD values for the whole body were significantly lower in both male and female CAH patients compared to healthy controls. Notably, BMD in the lumbar spine did not differ significantly between CAH patients and healthy individuals as a whole; however, men with CAH showed significantly lower lumbar spine BMD than their healthy counterparts.

The study further revealed that nearly 40% of male patients with CAH exhibited poor hormonal control, indicated by an androstenedione/testosterone ratio greater than one. Furthermore, 20% of young men with CAH presented with hypogonadism, a condition that may contribute to reduced BMD and the risk of osteoporosis.

"Reduced testosterone level and consequent hypogonadism could be one of the most important factors influencing these results,"

• Marianna Rita Stancampiano, Department of Pediatrics, Endocrine Unit, Endo-ERN Center for Rare Endocrine Diseases, IRCCS San Raffaele Hospital, Milan, Italy.

The research involved 56 prepubertal CAH patients due to 21-hydroxylase deficiency, with a median age of 7.9 years, of which 53.6% were girls. These patients received hydrocortisone three times daily and mineralocorticoid once or twice daily. Their glucocorticoid doses were calculated based on body surface area per day. In contrast, BMD was assessed using dual-energy x-ray absorptiometry in both lumbar spine and whole body measurements.

This study underscores the necessity for monitoring bone health in CAH patients on lifelong glucocorticoid therapy. Medical professionals must consider strategies to mitigate the adverse effects on bone density, particularly in young males at risk of developing osteoporosis.