Comparison of Densitometric Aspects during the Transition Period in Patients with Congenital and Acquired Pituitary Deficiency: First Argentine Experience

Hugo Boquete; Carla Boquete; Gabriela Ruibal; Martha Suarez; Miriam Azaretzky; Chavarria Eleonora Nuñez; Ana Sequera; Hugo Fideleff

The transition phase is the period from the end of puberty until achievement of full adult maturity. We report the results from 45 patients with pituitary deficiency (15-24.9years), 28 (16males) with congenital insufficiency (G1) and 17 (10males) with acquired disease (G2), evaluated at the end of GH therapy. All cases had confirmed GH deficiency; 89.2 % of cases from G1 had multiple pituitary deficiencies (TSH 23/28, LH/FSH 19/28, ACTH 15/28 and Prolactin 3/28), 94.1 % of cases from G2 had multiple deficiencies (TSH 16/17, LH/FSH 15/17, ACTH 13/17 and Prolactin 1/17); adequate replacement was confirmed in all cases. Patients with congenital disease received GH therapy (Median and range) from 7.75 years old (0.5-16.1) for 8.25 years (2.9-19.5) and those with acquired deficiency, from 12.85 years old (4-18) for 4.75 years (1.9-12.4). Heights achieved (cm) were: 148 (138.5-167.3) and 164.3 (152.2-176.5) in females and males from G1, respectively and 158 (143-164) and 168.25 (154.2-176), respectively from G2. We assessed body composition and bone mineral density (BMD) of the left femoral neck (FN) and lumbar spine L1-L4 (LS) by densitometry (DEXA, LUNAR equipment).


Md and Range	IGF1(SDS)	Lean mass(%)	Fat mass(%)	FN(z score)	LS(z score)
G1	-3.7*(-10 to -1.9)	60.1**(48.8 to 71.2)	35.6**(24.6 to 51.1)	-1.15***(-3.9 to 0.7)	-1.8****(-5.0 to 1.3)
G2	-3.5(-16 to 1.4)	59.9(44.5 to 71.9)	38.8 (20.5 to 52.6)	-1.1 (-1.6 to 0.9)	-1.57 (-2.4 to 0.8)
p vs G2	*0.019	**NS	**NS	***0.06	****0.0039

As 11/28 patients from G1 and 4/17 from G2 had near final height under the 3rd percentile, a sub-analysis of BMD was performed in patients with normal height and no significant differences were found in FN and LS. No differences were found in the number of patients with spontaneous or induced puberty in both groups.

Conclusions: The lower BMD of G1 might be related to different factors including, but not limited to, duration of the deficiency, severity (lower IGF-1 values) and/or lower final height. It is interesting to highlight that differences in BMD did not persist when excluding patients with low height. It is known that areal BMD may be underestimated in subjects with a small skeleton; therefore, in these cases, volumetric BMD measurement should be ideally performed. Our findings would suggest the need for GH therapy optimization during childhood, not only to improve final height, but also to achieve better bone quality.

ESPE Abstracts

P3-283