The reduction of bone mineral density in postmenopausal women with primary hyperparathyroidism is higher in the presence of concomitant GH secretion impairment

Abstract

Objective: To investigate, in a large group of postmenopausal primary hyperparathyroidism (PHP) women, whether the concomitance of GH deficiency (GHD) may contribute to the development of changes in bone mineral density (BMD). Design: GH secretion, bone status and metabolism were investigated in 50 postmenopausal women with PHP and in a control group of 60 women with no evidence of PHP, matched for age, age at menopause and body mass index (BMI). Methods: GH response to growth hormone-releasing hormone (GHRH)Carginine (Arg), femoral neck BMD (g/cm 2 ) by dual energy X-ray absorptiometry, BMI, serum-ionized calcium, parathyroid hormone (PTH) and markers of bone remodelling were evaluated in all patients and controls. Results: Among PHP patients, GH secretion was reduced (8.8G4.2 mg/l, range 1.1-16.5 mg/l) in 34 patients and normal (28.7G11.8 mg/l, range 17.9-55.7 mg/l) in the remaining 16 (P!0.05), no women in the control group had GHD (peak GH 33.8G10.9 mg/l, range 21.7G63.2 mg/l). Osteoporosis (T-score!K2.5) and osteopenia (T-scoreOK2.5 and !K1) were found in 73.5 and 17.6% of GHD patients, in 37.5 and 43.7% of patients with normal GH secretion and 3.1 and 27% of controls. T-score and BMD were not correlated with ionized calcium, age, age at menopause, BMI, GH peak and IGF-I but were correlated with serum PTH levels in both groups. T-score was correlated with serum levels of markers of bone remodelling only in PHP patients with GHD. Conclusions: Concomitant impairment of GH secretion may play a pathogenetic role in the occurrence of changes in bone mass observed in PHP and contribute to make them more severe. European Journal of Endocrinology 155 41-45

Primary hyperparathyroidism is associated with marked impairment of GH response to acylated ghrelin

“…Patients with PHP frequently have impaired somatotroph function, as indicated by reduction of both 24-h GH secretion and GH response to maximal provocative stimuli. [9][10][11][12][13][14] However, serum IGF-1 concentrations are rarely low in PHP, being more often within the age-related normal range, similar to patients with organic GH deficiency. 26 These findings have been confirmed by the present study; in addition, we used the potent GH secretagogue ghrelin, which has never been tested in patients with PHP, to evaluate GH secretory response.…”

“…Patients with PHP frequently have impaired somatotroph function, as indicated by reduction of both 24‐h GH secretion and GH response to maximal provocative stimuli 9–14 . However, serum IGF‐1 concentrations are rarely low in PHP, being more often within the age‐related normal range, similar to patients with organic GH deficiency 26 …”

“…the combination of GHRH and arginine (ARG)]. [9][10][11][12][13][14] However, GH secretory defect is transient because restoration of euparathyroidism by parathyroidectomy normalizes GH secretion in most cases. 12 The pathophysiological mechanism(s) underlying the impaired somatotroph cell function in PHP is still unclear.…”

“…Recently, it has been reported that most patients affected with primary hyperparathyroidism (PHP) due to parathyroid adenoma have impaired GH secretory function as evaluated by 24‐h GH secretion or by serum GH peak after maximal provocative stimuli [i.e. the combination of GHRH and arginine (ARG)] 9–14 . However, GH secretory defect is transient because restoration of euparathyroidism by parathyroidectomy normalizes GH secretion in most cases 12 .…”