Subject(s)
Calcium Gluconate/therapeutic use , Coronavirus Infections/complications , Coronavirus Infections/drug therapy , Hypocalcemia/drug therapy , Hypocalcemia/etiology , Pneumonia, Viral/complications , Pneumonia, Viral/drug therapy , Thyroidectomy , Aged , Angiotensin-Converting Enzyme Inhibitors/therapeutic use , Betacoronavirus/isolation & purification , Betacoronavirus/physiology , COVID-19 , Calcium/blood , Coronavirus Infections/diagnosis , Diagnosis, Differential , Drug Combinations , Dysarthria/diagnosis , Dysarthria/drug therapy , Dysarthria/etiology , Female , Headache/diagnosis , Headache/etiology , Humans , Hydrochlorothiazide/therapeutic use , Hypertension/complications , Hypertension/drug therapy , Hypocalcemia/diagnosis , Hypocalcemia/pathology , Hypoparathyroidism/diagnosis , Hypoparathyroidism/drug therapy , Hypoparathyroidism/etiology , Infusions, Intravenous , Lisinopril/therapeutic use , Pandemics , Paresthesia/diagnosis , Paresthesia/drug therapy , Paresthesia/etiology , Pneumonia, Viral/diagnosis , Renal Insufficiency, Chronic/complications , SARS-CoV-2 , Severity of Illness Index , Thyroidectomy/adverse effects , Treatment OutcomeSubject(s)
Activities of Daily Living/classification , Diabetes Mellitus, Type 2/drug therapy , Hypoglycemic Agents/therapeutic use , Metformin/therapeutic use , Aged , Disability Evaluation , Female , Humans , Hypoglycemic Agents/adverse effects , Male , Mental Status Schedule/statistics & numerical data , Metformin/adverse effects , PsychometricsSubject(s)
Aging/metabolism , Dehydroepiandrosterone/metabolism , Dehydroepiandrosterone/therapeutic use , Hormone Replacement Therapy/methods , Adult , Aged , Aged, 80 and over , Atherosclerosis/metabolism , Atherosclerosis/prevention & control , Bone Diseases, Metabolic/metabolism , Bone Diseases, Metabolic/prevention & control , Cognition Disorders/metabolism , Cognition Disorders/prevention & control , Dehydroepiandrosterone/deficiency , Female , Humans , Italy , Male , Middle AgedABSTRACT
BACKGROUND: Quantitative ultrasound bone densitometry (QUBD) is a new method to assess bone mineral density and bone microarchitecture. Corticosteroid (CS) therapy may diminish bone mass, alter bone quality and may influence growth hormone (GH) secretion and bone metabolism markers. Therefore, the aim of this study was to evaluate the effects of long-term therapy with inhaled CSs (ICSs) on structural bone characteristics and their correlations with GH secretion and bone markers in asthmatic patients. METHODS: In a cross-sectional study, we enrolled 60 adult patients with mild to moderate persistent asthma: 22 on chronic (>1 year) ICS therapy, 10 naive to ICSs treatment and 28 healthy control subjects. The groups were matched for age and BMI. Each subject underwent to QUBD at the phalanxes to assess bone microarchitecture by ultrasound bone profile index (UBPI), bone density by amplitude-dependent speed of sound (AdSos); test with GH-releasing hormone (GHRH) injection with calculation of peak GH and the Delta GH (peak GH-basal GH); and hormonal and bone markers measurements. RESULTS: Asthmatics treated with long-term ICS therapy showed a lower UBPI (P < 0.01) compared to controls (49.8 +/- 19.3 vs. 77.0 +/- 10.1, respectively) and to asthmatics never taking ICSs (73.2 +/- 9.6). In ICS-treated asthmatics, DeltaGH and GH-peak showed a significant correlation with UBPI. A significant difference was observed comparing asthmatics treated with ICSs to controls and asthmatics naive to ICSs in GH response to GHRH iv bolus. Serum osteocalcin was significantly reduced in asthmatic patients treated with ICSs. CONCLUSIONS: In asthmatic patients, long-term ICSs treatment produces negative effects on bone quality assessed by QUBD, and such effects are associated to an impaired GH secretion.
Subject(s)
Adrenal Cortex Hormones/adverse effects , Anti-Asthmatic Agents/adverse effects , Asthma/drug therapy , Budesonide/adverse effects , Growth Hormone-Releasing Hormone , Human Growth Hormone/blood , Administration, Inhalation , Adrenal Cortex Hormones/administration & dosage , Adult , Anti-Asthmatic Agents/administration & dosage , Asthma/blood , Body Mass Index , Bone Density/drug effects , Bone Remodeling/drug effects , Budesonide/administration & dosage , Cross-Sectional Studies , Female , Humans , Long-Term Care , Male , Middle Aged , Osteocalcin/blood , Statistics as Topic , UltrasonicsABSTRACT
BACKGROUND: Some studies have demonstrated that the function of the growth hormone (GH)-insulin-like growth factor (IGF)-1 axis is significantly impaired in patients with oral corticosteroid (CS)-induced osteoporosis. The aim of study was to investigate the effects of long-term therapy with inhaled CSs (ICSs) on the hypothalamic-pituitary-GH axis by the GH response to GH-releasing hormone (GHRH), as well as bone turnover, in adult asthmatic patients. DESIGN: Cross-sectional study. PATIENTS: Twenty-seven adult subjects with mild-to-moderate persistent asthma (long-term ICS therapy [ie, > 1 year], 20 patients; naive to ICS treatment, 7 patients) and 10 control subjects. MEASUREMENTS: Each subject underwent testing with an IV bolus (1 mug/kg) injection of human GHRH, and samples of GH were taken 15 min before the GHRH injection, at 0 min (ie, at the time of GHRH injection), and at 15, 30, 45, 60, and 90 min after injection to obtain values for peak GH and DeltaGH. At baseline, samples of serum IGF-1 and blood-urine were collected for bone turnover markers. RESULTS: The GH response to GHRH was significantly reduced in asthmatic patients receiving ICSs (peak GH, p < 0.05; and DeltaGH, p < 0.01) in comparison with control subjects and asthmatic patients who were naive to ICS therapy (peak GH and DeltaGH, p < 0.01). Baseline IGF-1 levels were similar in the three groups. Serum osteocalcin, a marker of bone formation, was significantly reduced (p < 0.01) and correlated with GH peak (r(2) = 0.34; p = 0.007) in asthmatic patients who were treated with ICSs. CONCLUSIONS: We conclude that GH secretion in response to GHRH is significantly reduced in adult asthmatic patients receiving therapy with ICS and that such inhibition could play a negative role in bone metabolism.
