A concomitant decrease in cortical and trabecular bone mass in isolated hypogonadotropic hypogonadism and gonadal dysgenesis

To assess the impact of hypogonadism on bone mineral density, we performed a cross-sectional study of 70 amenorrheic women, comprising 22 cases of gonadal dysgenesis and 48 cases of isolated hypogonadotropic hypogonadism (IHH). Bone mineral density was measured by DEXA at four sites: the femur neck, Ward's triangle, trochanter, and lumbar spine (L2-4). The results were compared to those of a control group consisting of 60 age-matched, normal-cycling women. Bone mineral densities around age 20 were already significantly lower at all four sites in patients with IHH and gonadal dysgenesis when compared with controls, suggesting that these patients failed to achieve peak bone mass during pubertal development. In patients with IHH, the initial BMD around age 18-20 were significantly lower at all four sites and the decrease in bone density continued rapidly during the early twenties up to age 25, and then it slowed markedly thereafter. Bone biochemical marker, ICTP and osteocalcin were significantly negatively correlated with age and remained increased until age 40, which was reminiscent of menopausal bone loss pattern such as high bone turn-over in the early twenties, followed by slow bone loss in the late twenties. In patients with gonadal dysgenesis, bone biochemical marker, ICTP and osteocalcin were also significantly negative correlated with age and remained increased until age 40, but no significant changes in BMD were noted as a function of age, which may be attributed to the small sample size and slow bone loss. These findings suggest that the initiation of prompt and timely therapeutic intervention as early as possible in the menarchal period and throughout the remainder of life, particularly during the period associated with rapid bone loss.

Alteraçöes na densitometria óssea em pacientes com hipogonadismo hipergonadotrófico / Bone densitometry changes among patients with hypergonadotrophic hypogonadism

INTRODUÇÄO: A osteoporose e a osteopenia säo alteraçöes na densidade óssea (DO) associadas a situaçöes que cursam com hipoestrogenismo, näo só na pós menopausa mas também em casos de hipogonadismos hipergonadotróficos. OBJETIVOS: avaliar alteraçöes na DO de pacientes com hipogonadismo näo relacionado a climatério (Síndrome de Turner, Disgenesia Gonadal Pura, Falência Ovariana Precoce), e o efeito de Terapia de Reposiçäo Hormonal (TRH) na prevençäo ou reversäo de tais alteraçöes. PACIENTES E MÉTODOS: Nossa casuística constou de 14 pacientes atendidas no setor de Reproduçäo Humana do Hospital das Clínicas da Faculdade de Medicina de Ribeiräo Preto da Universidade de Säo Paulo. Dessas pacientes 6 apresentavam Síndrome de Tuner, 4 eram portadoras de Disgenesia Gonadal Pura e 4 tinham Falência Ovariana Precoce. O diagnóstico se baseou na história clínica, exame físico, dosagens hormonais e avaliaçäo genética com cariótipo. Todas foram submetidas à DO com o densitômetro de dupla radiaçäo Sophos L-XRA. RESULTADOS: Encontramos diminuiçäo na DO em pacientes de todos os grupos, näo havendo diferença significativa entre os três grupos. As pacientes que näo apresentaram alteraçöes na DO foram aquelas com menor intervalo de tempo entre início da sintomatologia de hipoestrogenismo e instituiçäo de TRH. Pacientes que permaneceram por mais de 3 anos sem TRH apresentaram alteraçöes na densidade óssea proporcional ao tempo de deprivaçäo hormonal. Também observamos que pacientes que entraram num processo de falência ovariana após os 20 anos de idade têm melhor prognóstico quanto à quantidade de massa óssea. CONCLUSÖES: Enfatizamos com esses dados a necessidade de TRH nessas pacientes, com finalidade de prevenir alteraçöes na densidade óssea conseqüentes ao hipoestrogenismo.