Document Detail

Long-term maintenance of the anabolic effects of GH on the skeleton in successfully treated patients with acromegaly.
MedLine Citation:
PMID:  15762187     Owner:  NLM     Status:  MEDLINE    
INTRODUCTION: The anabolic actions of growth hormone (GH) are well documented. In acromegaly, the skeletal effects of chronic GH excess have been mainly addressed by evaluating bone mineral density (BMD). Most data were obtained in patients with active acromegaly, and apparently high or normal BMD was observed in the absence of hypogonadism. Data on BMD are not available after successful treatment of acromegaly. Whether the positive effect of GH excess on bone mass is maintained in the long term after clinical and biochemical cure of acromegaly remains to be established. PATIENTS AND METHODS: In a cross-sectional study design, lumbar spine and femoral neck BMD was measured in 79 acromegalic patients cured or well controlled on octreotide treatment (45 male and 34 female patients; mean age 57+/-1 years). Successful treatment (by surgery, radiotherapy and/or use of octreotide) was defined as normal age-adjusted IGF-I. Mean time after biochemical remission was 10.2+/-7 years. RESULTS: Normal or increased BMD was observed at the femoral neck and lumbar spine in both men and women in remission after treatment for acromegaly. Similar results were obtained in patients in remission for 5 years or longer. Osteoporosis was present in 15% of the patients, with similar prevalence in men and women. There was no relationship between BMD and duration or severity of GH excess before treatment, gonadal status and presence of pituitary hormone deficiencies. Pituitary irradiation was a strong negative predictor of bone mass at the femoral neck. Long-term bone loss was observed only at the femoral neck. CONCLUSION: Our data suggest that the anabolic effect of GH on trabecular and cortical bone remains demonstrable after remission of acromegaly, although it may not be maintained at cortical sites in the long term. In the present study, the lack of effect of gonadal status on BMD may be explained by the presence of only mild hypogonadism and by our policy of prompt hormonal replacement therapy for severe hypogonadism. The negative effect of pituitary irradiation on femoral neck BMD remains intriguing, although it is probably related to some degree of the diminished GH secretion frequently observed after this form of treatment.
Nienke R Biermasz; Neveen A T Hamdy; Alberto M Pereira; Johannes A Romijn; Ferdinand Roelfsema
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  European journal of endocrinology / European Federation of Endocrine Societies     Volume:  152     ISSN:  0804-4643     ISO Abbreviation:  Eur. J. Endocrinol.     Publication Date:  2005 Jan 
Date Detail:
Created Date:  2005-03-14     Completed Date:  2005-03-31     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  9423848     Medline TA:  Eur J Endocrinol     Country:  England    
Other Details:
Languages:  eng     Pagination:  53-60     Citation Subset:  IM    
Department of Endocrinology and Metabolic Diseases, Leiden University Medical Centre, Leiden, The Netherlands.
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MeSH Terms
Absorptiometry, Photon
Acromegaly / blood,  drug therapy*,  metabolism
Aged, 80 and over
Alkaline Phosphatase / blood
Bone Density / drug effects*
Bone Remodeling / drug effects
Bone and Bones / drug effects,  metabolism
Cross-Sectional Studies
Follow-Up Studies
Human Growth Hormone / blood,  metabolism*
Hydroxyproline / blood
Insulin-Like Growth Factor I / metabolism
Longitudinal Studies
Middle Aged
Octreotide / therapeutic use*
Osteocalcin / blood
Reg. No./Substance:
104982-03-8/Osteocalcin; 12629-01-5/Human Growth Hormone; 51-35-4/Hydroxyproline; 67763-96-6/Insulin-Like Growth Factor I; 83150-76-9/Octreotide; EC Phosphatase

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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