Effect of DHEA supplementation on serum IGF-1, osteocalcin, and bone mineral density in postmenopausal, glucocorticoid-treated women.

PURPOSE: DHEA therapy increases bone formation in postmenopausal women. We have found only a few reports of dehydroepiandrosterone replacement therapy in women receiving long-term glucocorticoid medication. The purpose of this study was to establish whether DHEA replacement therapy may be useful in the treatment of steroid-induced osteoporosis in postmenopausal women. MATERIALS AND METHODS: Nineteen women, aged 50-78 years, treated at least for three years with average daily doses of more than 7.5 mg prednisone, with T-score L2/L4<-1.5 and bisphosphonates intolerance, were enrolled to the study. For the first year of the study the patients were given calcium, vitamin D3 and thiazide diuretics. For another year the patients received orally micronized DHEA 25-50 mg daily. Before the study, after twelve months of Calcium/D3 therapy, then after six weeks and six months of DHEA therapy, serum concentrations of DHEAS, androstenedione, testosterone, estradiol, FSH, IGF-1 and osteocalcin were assessed. Bone mineral density (BMD) in lumbar spine and femoral neck was measured before the treatment, after a year on Calcium/D3 and after six and twelve months of DHEA replacement therapy. RESULTS: In all treated women, DHEA significantly increased serum DHEAS, androstenedione and testosterone concentrations. A significant elevation of serum IGF-1 and osteocalcin concentrations was found as early as after six weeks of DHEA treatment. A significant increase of bone mineral density in the lumbar spine and femoral neck was observed after six and twelve months of DHEA treatment. CONCLUSION: Our results suggest a beneficial role of DHEA replacement therapy in the treatment of steroid-induced osteoporosis.

Incidentally discovered adrenal tumors: a lesson from observation of 1,444 patients.

This study was aimed at summarizing our experience in the management of 1,444 patients with incidentally found adrenal tumors observed at a single endocrinological centre. Hormonal determinations were performed in all patients at the beginning of the observation period to detect subclinical adrenal hyperfunction. The imaging phenotype on CT and MRI was analyzed for defining the malignant potential of the tumors. Based on the results of these examinations we diagnosed among our cohort probably benign masses in 87%, malignant tumors in 10% (adrenal carcinoma - 9%), and metastases in 3%. Subclinical hyperfunction was diagnosed in 8%; the most frequent was the pre-Cushing's syndrome. A subgroup of 480 patients (33%) was submitted to surgery because of oncological or endocrinological indications. The patients not qualified for surgery were carefully controlled by imaging and hormonal examinations. Malignancy is the most serious risk in the group of patients with incidentally discovered adrenal tumors.

1,161 patients with adrenal incidentalomas: indications for surgery.

BACKGROUND AND AIMS: The aim of this study is to analyze the clinical data and criteria for surgery in a group of over 1,100 patients with adrenal incidentalomas (AI) observed at the Department of Endocrinology. PATIENTS AND METHODS: The material consisted of 1,161 patients (842 women and 319 men, 10-87 years old) with AI ranging in size from 1.0 to 23.0 cm. The methods included clinical examination, imaging studies, hormonal determinations in the blood and in the urine as well as histological and immunocytochemical investigations in 390 patients treated by surgery. RESULTS: Basing on these studies, we diagnosed 112 patients with primary malignant adrenal tumors (100 with carcinoma), 45 with metastatic infiltrations, and 1,004 with probable benign AI. Imaging phenotypes (especially high density on computed tomography, CT) were characteristic of malignant and chromaffin tumors. Subclinical adrenal hyperactivity was found in 8% of the patients with pre-Cushing's syndrome as the most frequent form (6.5%). Chromaffin tumors were detected in 3%. CONCLUSIONS: (1) Indications for surgery include malignant tumors (both primary and metastatic), tumors with subclinical hyperfunction, and chromaffin tumors. High density on CT, >20 HU, appeared to be an important indication for surgery. (2) A slight prevalence of oncological indications over endocrinological indications (14 vs. 11%) was found.

[The effect of growth hormone replacement therapy on markers of bone formation and bone mineral density in elderly men]. / Wplyw uzupelniania niedoborów hormonu wzrostu na wskazniki syntezy i gestosc mineralna kosci u starszych mezczyzn.

OBJECTIVE: Decline in growth hormone (GH) secretion and serum levels of insulin-like growth factor-1 (IGF-1) during ageing may be a causal factor in the development of osteopenia. The purpose of this study was to test the effects of GH-replacement therapy on bone metabolism and mineral density in healthy men over 40 years old. MATERIAL: 18 healthy men aged 60.2 +/- 2.4 (avg +/- SEM) with mean body weight 78.6 +/- 4.6 kg and body mass index (BMI) 26.5 +/- 1.4 kg/m2. Diagnosis of growth hormone deficiency was based on serum IGF-1 levels below 200 micrograms/L (138.1 +/- 9.2), abolished GH nocturnal surge and diminished glucagon-stimulated GH secretion compared to reference group of young men (16.2 +/- 1.8 to 30.6 +/- 4.7 micrograms/L/hour; p < 0.02 and 10.8 +/- 1.0 to 44.1 +/- 15.3 micrograms/L/hour; p < 0.02 respectively). Nine healthy men aged 27.5 +/- 1.3 were recruited as a control subjects. Their body weight was 76.3 +/- 2.2 kg and BMI 21.3 +/- 0.6 kg/m2. METHODS: The subjects received human, recombinant GH (rhGH) daily subcutaneously during 12 months in dose individually adjusted to maintain optimal (280-350 micrograms/L) serum IGF-1 level. Initial dose was 0.125 IU/kg b.w./week. Before and after 6 and 12 months of therapy clinical and laboratory exams, including serum GH, IGF-1, calcium, phosphate, osteocalcin, glucose, insulin levels and alkaline phosphatase (AP) activity were obtained. Lumbar spine and femoral neck bone mineral density (BMD) were measured by dual-energy X-ray absorptiometry. RESULTS: rhGH administration for 12 months led to a significant increase in mean serum IGF-1 levels, from 138.1 +/- 9.2 to 279.4 +/- 26.3 micrograms/L (p < 0.001). Mean serum osteocalcin concentration rose from 19.4 +/- 1.7 to 34.4 +/- 4.7 micrograms/L (p < 0.004), and serum AP activity changed nearly significantly, from 78.0 +/- 4.8 to 88.1 +/- 7.2 U/L. Lumbar spine and femur neck BMD increased significantly after 12 months, from 1.092 +/- 0.05 to 1.119 +/- 0.06 g/cm2 (p < 0.05) and from 0.886 +/- 0.04 to 0.905 +/- 0.04 g/cm2 (p < 0.05), respectively. CONCLUSION: Growth hormone replacement therapy in elderly men may be regarded as a method useful to protect against osteoporosis progression.