Serum Osteocalcin and Insulin-Like Growth Factor I Levels in Children with Congenital Adrenal Hyperplasia

Abstract

Patients with the virilizing forms of congenital adrenal hyperplasia (CAH) need a life-long glucocorticoid replacement therapy and also an additional mineralocorticoid replacement in cases with the salt-wasting form of the disease. Glucocorticoids are reported to decrease the serum osteocalcin levels and to inhibit the effects of insulin-like growth factor I (IGF-I). To collect data on the age related patterns of osteocalcin and IGF-I production in patients with CAH, measurements of these compounds have been carried out in a considerably large sample of treated CAH patients and control subjects in childhood and adolescence. Data of 62 patients between 0.3–19 years of age were compared to the data of 188 control children. Osteocalcin and IGF-I were determined by radioimmunoassay. A lower than normal level of serum osteocalcin was found in both male and female patients at chronological ages above 11.6 and 9.6 years, respectively. Furthermore, no pubertal osteocalcin peak could be seen when data were evaluated according to the bone age. Serum IGF-I levels were higher in male CAH patients at the chronological age of 0.3–15.5 years and in female patients at the chronological age of 4.6–9.5 years. In pubertal years serum IGF-I concentrations were lower in CAH patients when data were evaluated according to the bone age. We conclude that serum osteocalcin is decreased during and after puberty in CAH patients on replacement doses of glucocorticoids. Normal to elevated serum levels of IGF-I in treated CAH cases suggest that the shorter final height of these patients may not be due to the decreased activity in the growth hormoneIGF-I axis, but rather to the advanced bone maturation and the premature epiphyseal fusion.

Height, Bone Mineral Density and Bone Markers in Congenital Adrenal Hyperplasia

“…There was only a tendency for NC patients to have not significantly higher osteocalcin levels, reflecting either a better osteoblast function following a lower corticosteroid dosage or perhaps only a different age. Our results on bone markers of neoformation and resorption are in agreement with those of Girgis and Winter [4], while other authors found lower than normal osteocalcin [22, 23, 24]and NTx [24]levels in their patients. There is no clear explanation for these different findings.…”

Bone Mineral Status in Children with Congenital Adrenal Hyperplasia

“…Although the majority of previous studies in CAH have demonstrated normal BMD and BMC, consistent with our findings, the literature suggests that children and adults with this diagnosis have depressed bone turnover, reflected by altered patterns of bone turnover markers 31,32 . Our bone turnover data support the theory that there is an uncoupling of bone turnover in patients with CAH, with low osteocalcin values and elevated N-telopeptide levels seen in the majority of participants.…”

Longitudinal analysis of growth and puberty in 21-hydroxylase deficiency patients

“…The growth hormone IGF-I axis was not responsible for the loss in final height potential during puberty as normal to increased serum levels of IGF-I during puberty in treated CAH patients were found. 33 In non-salt wasting patients, females were diagnosed earlier than NSW males with a less advantaged bone age and better height prognosis. In males, loss of final height was more pronounced because of late diagnosis.…”