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Role of estrogen and androgen in pubertal skeletal physiology.
[aromatase deficiency]
Since
both
estrogen
and
androgen
are
present
in
each
sex
,
it
has
been
difficult
to
discern
the
exact
role
that
each
sex
steroid
plays
in
skeletal
physiology
.
However
,
studying
clinical
syndromes
in
which
there
is
either
only
estrogen
or
androgen
action
has
allowed
us
to
gain
insight
into
the
unique
role
that
each
sex
steroid
plays
in
the
growing
skeleton
.
In
complete
androgen
insensitivity
syndrome
(
AIS
)
the
only
functional
sex
steroid
receptor
is
that
for
estrogen
.
Effected
XY
females
have
a
pubertal
growth
spurt
that
is
typical
of
normal
females
,
both
in
magnitude
and
timing
.
Individuals
with
AIS
have
a
mild
reduction
in
bone
density
but
it
is
difficult
to
distinguish
whether
this
is
the
result
of
androgen
resistance
or
estrogen
deficiency
.
These
observations
suggest
that
estrogen
action
only
is
sufficient
to
induce
a
normal
pubertal
growth
spurt
,
epiphyseal
maturation
,
and
near
normal
bone
mineral
accretion
in
women
.
Until
recently
,
the
skeletal
effects
of
estrogen
were
not
thought
to
be
of
importance
in
the
male
.
Conventional
wisdom
dictated
that
,
in
the
male
,
testosterone
mediated
these
skeletal
changes
.
The
notion
that
estrogen
is
of
little
importance
in
the
male
has
been
challenged
by
the
recent
discovery
of
two
human
syndromes
in
which
estrogen
action
is
lacking
.
In
males
with
either
estrogen
resistance
(
inability
to
respond
to
circulating
estrogen
)
or
aromatase
deficiency
(
inability
to
synthesize
estradiol
)
,
as
a
result
of
the
lack
of
estrogen
action
,
a
pubertal
growth
spurt
does
not
appear
to
occur
.
Furthermore
,
complete
epiphyseal
maturation
does
not
take
place
allowing
for
continued
growth
in
adulthood
and
resultant
tall
stature
.
Finally
normal
bone
mineral
accretion
does
not
take
place
resulting
in
severe
osteoporosis
.
These
findings
indicate
that
estrogen
plays
a
critical
role
in
skeletal
physiology
of
males
as
well
as
females
.
Diseases
Validation
Diseases presenting
"bone mineral accretion in women"
symptom
aromatase deficiency
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