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Sexual difference in bone geometry of adult patients with classical congenital adrenal hyperplasia: data using peripheral quantitative computed tomography.
[congenital adrenal hyperplasia]
Glucocorticoid
treatment
may
influence
bone
and
muscle
development
in
patients
with
congenital
adrenal
hyperplasia
(
CAH
)
.
This
study
evaluated
bone
mineral
density
(
BMD
)
,
bone
geometry
and
muscle
mass
.
73
adult
patients
with
classical
CAH
were
followed
.
BMD
,
bone
geometry
and
muscle
mass
were
measured
using
peripheral
quantitative
computed
tomography
(
pQCT
)
.
Glucocorticoid-equivalent
doses
throughout
life
were
calculated
and
at
the
time
pQCT
androgen
levels
were
measured
.
In
males
the
mean
standard
deviation
(
SD
)
score
for
trabecular
BMD
(
-
0
.
33
±
0
.
71
)
was
reduced
,
whereas
mean
cortical
BMD
(
1
.
05
±
1
.
11
)
was
elevated
.
Mean
total
(
0
.
86
±
1
.
12
)
and
medullary
cross-sectional
area
(
CSA
;
1
.
12
±
1
.
17
)
were
significantly
increased
(
p
<
0
.
001
)
.
In
all
patients
SD
scores
for
cortical
thickness
(
-
0
.
65
±
0
.
91
)
and
muscle
CSA
(
-
0
.
83
±
0
.
91
)
were
reduced
.
Treatment
duration
was
associated
with
lower
trabecular
BMD
in
males
(
r
=
-
0
.
63
,
p
<
0
.
001
)
.
Suppressed
androgens
and
simple
virilizing
CAH
had
an
adverse
effect
on
the
muscle
CSA
SD
score
(
OR
0
.
58
and
0
.
46
,
respectively
,
p
<
0
.
05
)
.
There
was
a
sexual
difference
with
enlarged
total
and
medullary
CSA
in
females
,
whereas
in
males
trabecular
BMD
was
reduced
and
cortical
BMD
elevated
.
Cortical
thickness
and
muscle
CSA
were
reduced
in
all
CAH
patients
with
a
possible
long
-term
impact
on
bone
development
and
stability
.
Monitoring
of
bone
and
muscle
development
might
be
warranted
.