Clinical and molecular studies related to bone metabolism in patients with congenital adrenal hyperplasia
- 
            
            
        Silvia Martín
        
 , Liliana Muñoz , Adriana Pérez , Gabriela Sobrero , Gabriela Picotto , Mariana Ochetti , Agata Carpentieri , Liliana Silvano , Gabriela Díaz de Barboza , Malvina Signorino , Casilda Rupérez , Patricia Bertolotto , María Rosa Ulla , Claudia Pellizas , María Montesinos , Nori Tolosa de Talamoniand Mirta Miras
 
Abstract
Patients with congenital adrenal hyperplasia (CAH) due to 21-hydroxylase deficiency need glucocorticoid (GC) therapy, which alters bone mineral metabolism. We analyze clinical and biochemical parameters and different polymorphisms of candidate genes associated with bone mineral density (BMD) in CAH patients. The CAH patients treated with GC and healthy controls were studied. Anthropometric parameters, biochemical markers of bone turnover, and BMD were evaluated. Polymerase chain reaction technique was used to genotype different candidate genes. The 192-192 genotype frequency (IGF-I) was lower in poorly controlled patients than that from controls. In CAH patients, FF genotype (vitamin D receptor, VDR) correlated with lower lumbar spine BMD and there was a significant association between the 0-0 genotype (IGF-I) and high values of β-CrossLaps and a low total BMD. This study contributes to understanding of the association of genetic determinants of BMD with the variable response to GC treatment in CAH patients and demonstrates the usefulness of these genetic polymorphisms.
Acknowledgments
This work was supported by a Grant from FONCYT- UNC (PICTO 2005-35960) (Dr. N.T.de T.). Prof. Dr. Tolosa de Talamoni, Dr. Picotto, and Dr. Carpentieri are members of the Investigator Career from CONICET.
References
1. Speiser PW, White PG. Congenital adrenal hyperplasia. N Engl J Med 2003;349:776–88.10.1056/NEJMra021561Search in Google Scholar PubMed
2. Gallagher MP, Levine LS, Oberfield SE. A review of the effects of therapy on growth and bone mineralization in children with congenital adrenal hyperplasia. Growth Horm IGF Res 2005;15:S26–30.10.1016/j.ghir.2005.06.006Search in Google Scholar PubMed
3. Hoepffner W, Kaufhold A, Willgerodt H, Keller E. Patients with classic congenital adrenal hyperplasia due to 21-hydroxylase deficiency can achieve their target height: the Leipzig experience. Horm Res 2008;70:42–50.10.1159/000129677Search in Google Scholar PubMed
4. Lin-Su K, New M. Effects of adrenal steroids on bone metabolism of children with congenital adrenal hyperplasia. Ann NY Acad Sci 2007;1117:345–51.10.1196/annals.1402.040Search in Google Scholar PubMed
5. Mazziotti G, Angeli A, Bilezikian JP, Canalis E, Giustina A. Glucocorticoid-induced osteoporosis: an update. Trends Endocrinol Metab 2006;17:144–9.10.1016/j.tem.2006.03.009Search in Google Scholar PubMed
6. Cameron FJ, Kaymakci B, Byrt EA, Ebeling PR, Warne GL, et al. Bone mineral density and body composition in congenital adrenal hyperplasia. J Clin Endocrinol Metab 1995;80:2238–43.Search in Google Scholar
7. Sciannamblo M, Russo G, Cuccato D, Chiumello G, Mora S. Reduced bone mineral density and increased bone metabolism rate in young adult patients with 21-hydroxylase deficiency. J Clin Endocrinol Metab 2006;91:4453–58.10.1210/jc.2005-2823Search in Google Scholar PubMed
8. Hargitai G, Hosszú E, Halász Z, Sólyom J. Serum osteocalcin and insulin-like growth factor levels in children with congenital adrenal hyperplasia. Horm Res 1999;52:131–9.10.1159/000023449Search in Google Scholar PubMed
9. Girgis R, Winter J. The effects of glucocorticoid replacement therapy on growth, bone mineral density and bone turnover markers in children with congenital adrenal hyperplasia. J Clin Endocrinol Metab 1997;82:3926–9.10.1210/jcem.82.12.4320Search in Google Scholar PubMed
10. Massart F, Marcucci G, Brandi ML. Pharmacogenetics of bone treatmens: the VDR and ERalpha gene story. Pharmacogenomics 2008;9:733–46.10.2217/14622416.9.6.733Search in Google Scholar PubMed
11. Fleury I, Beaulieu P, Primeau M, Labuda D, Sinnett D, et al. Characterization of the BclI polymorphism in the glucocorticoid receptor gene. Clin Chem 2003;49:1528–31.10.1373/49.9.1528Search in Google Scholar PubMed
12. Koetz KR, van Rossum EF, Ventz M, Diederich S, Quinkler M. BclI polymorphism of the GCR gene is associated with increased bone resorption in patients on glucocorticoid replacement therapy. Clin Endocrinol (Oxf) 2013;78:831–7.10.1111/cen.12096Search in Google Scholar
13. Miyao M, Hosoi T, Inoue S, Hoshino S, Shiraki M, et al. Polymorphism of insulin-like growth factor I gene and bone mineral density. Calcif Tissue Int 1998;63:306–11.10.1007/s002239900532Search in Google Scholar
14. Cetinkaya S, Kara C. The effect of glucocorticoid replacement therapy on bone mineral density in children with congenital adrenal hyperplasia. J Pediatr Endocrinol Metab 2011;24:265–9.10.1515/jpem.2011.189Search in Google Scholar
15. Zanchetta J, Plotkin L, Alvarez Figueira M. Bone mass in children: normative values for the 2-20 year-old population. Bone 1995;6:393S–9S.10.1016/8756-3282(95)00082-OSearch in Google Scholar
16. Silvano L, Miras M, Perez A, Picotto G, Diaz de Barboza G, et al. Comparative analysis of clinical, biochemical and genetic aspects associated with bone mineral density in small for gestational age children. J Pediatr Endocrinol Metab 2011;24:511–17.10.1515/jpem.2011.196Search in Google Scholar PubMed
17. Weber JL, May PE. Abundant class of human DNA polymorphisms which can be typed using the polymerase chain reaction. Am J Hum Genet 1989;44:388–96.Search in Google Scholar
18. Gergics P, Patocs A, Majnik J, Balogh K, Szappanos A, et al. Detection of the Bcl I polymorphism of the glucocorticoid receptor gene by single-tube allele-specific polymerase chain reaction. J Steroid Biochem Mol Biol 2006;100:161–6.10.1016/j.jsbmb.2006.04.004Search in Google Scholar PubMed
19. Nebesio TD, Eugster EA. Growth and reproductive outcomes in congenital adrenal hyperplasia. Int J Endocrinol 2010;298937. doi: 10.1155/2010/298937.10.1155/2010/298937Search in Google Scholar PubMed PubMed Central
20. Martín S, Muñoz L, Pérez A, Sobrero G, Picotto G, et al. Clinical, molecular and bone metabolism studies in patients with congenital adrenal hyperplasia. Bone 2011;48:S284.10.1016/j.bone.2011.03.724Search in Google Scholar
21. Guercio G, Rivarola MA, Chaler E, Maceiras M, Belgorosky A. Hydrocortisone treatment in girls with congenital adrenal hyperplasia inhibits serum dehydroepiandrosterone sulfate and affects the GH-IGF-I system. J Pediatr Endocrinol Metab 2009;22:255–61.10.1515/JPEM.2009.22.3.255Search in Google Scholar
22. Cunha HM, Elias LL, Camacho-Hubner C, Moreira AC, Martinelli CE Jr. Different states of clinical control are associated with changes in IGF-I and IGFBPs in children with congenital adrenal hyperplasia due to 21-hydroxylase deficiency. Clin Endocrinol 2004;61:94–101.10.1111/j.1365-2265.2004.02075.xSearch in Google Scholar PubMed
23. Van der Kamp HJ, Otten BJ, Buitenweg N, De Muinck Keizer-Schrama SM, Oostdijk W, et al. Longitudinal analysis of growth and puberty in 21-hydroxylase deficiency patients. Arch Dis Child 2002;87:139–44.10.1136/adc.87.2.139Search in Google Scholar PubMed PubMed Central
24. Stikkelbroeck NM, Oyen WJ, van der Wilt GJ, Hermus AR, Otten BJ. Normal bone mineral density and lean body mass, but increased fat mass, in young adult patients with congenital adrenal hyperplasia. J Clin Endocrinol Metab 2003;88:1036–42.10.1210/jc.2002-021074Search in Google Scholar PubMed
25. Chakhtoura Z, Bachelot A, Samara-Boustani D, Ruiz JC, Donadille B, et al. Impact of total cumulative glucocorticoid dose on bone mineral density in patients with 21-hydroxylase deficiency. Eur J Endocrinol 2008;158:879–87.10.1530/EJE-07-0887Search in Google Scholar PubMed
26. King JA, Wisniewski AB, Bankowski BJ, Carson KA, Zacur HA, et al. Long-term corticosteroid replacement and bone mineral density in adult women with classical congenital adrenal hyperplasia. J Clin Endocrinol Metab 2006;91:865–9.10.1210/jc.2005-0745Search in Google Scholar PubMed
27. Bachelot A, Plu-Bureau G, Thibaud E, Laborde K, Pinto G, et al. Long-term outcome of patients with congenital adrenal hyperplasia due to 21-hydroxylase deficiency. Horm Res 2007;67:268–76.10.1159/000098017Search in Google Scholar PubMed
28. van Rossum EF, Lamberts SW. Polymorphisms in the glucocorticoid receptor gene and their associations with metabolic parameters and body composition. Recent Prog Horm Res 2004;59:333–57.10.1210/rp.59.1.333Search in Google Scholar PubMed
29. Szappanos A, Patócs A, Tõke J, Boyle B, Sereg M, et al. BclI polymorphism of the glucocorticoid receptor gene is associated with decreased bone mineral density in patients with endogenous hypercortisolism. Clin Endocrinol (Oxf) 2009;71:636–43.10.1111/j.1365-2265.2009.03528.xSearch in Google Scholar PubMed
30. Willing MC, Torner JC, Burns TL, Janz KF, Marshall T, et al. Gene polymorphisms, bone mineral density and bone mineral content in young children: the Iowa bone development study. Osteoporosis Int 2003;14:650–8.10.1007/s00198-003-1416-1Search in Google Scholar PubMed
31. Sainz J, Van Tornout J, Sayre J, Kaufman F, Gilsanz V. Association of collagen type 1 α1 gene polymorphism with bone density in early childhood. J Clin Endocrinol Metab 1999;84:853–5.Search in Google Scholar
32. Suuriniemi M, Kovanen V, Mahonen A, Alén M, Wang Q, et al. Colia1 SP1 polymorphism associates with bone density in early puberty. Bone 2006;39:591–7.10.1016/j.bone.2006.02.053Search in Google Scholar PubMed
33. Ralston SH, Uitterlinden AG, Brandi ML, Balcells S, Langdahl BL, et al. Large-scale evidence for the effect of the COLIA1 SP1polymorphism on osteoporosis outcomes: the GENOMOS study. PLoS Med 2006;3:e90.10.1371/journal.pmed.0030090Search in Google Scholar PubMed PubMed Central
34. Peralta López M, Centeno V, Miras M, Silvano L, Pérez A, et al. Vitamin D receptor genotypes are associated with bone mass in patients with Turner syndrome. J Pediatr Endocr Metab 2011;24:307–12.Search in Google Scholar
35. Seldin DW, Esser PD, Alderson PO. Comparison of bone density measurements from different skeletal sites. J Nucl Med 1988;29:168–73.Search in Google Scholar
36. Abrahamsen B1, Stilgren LS, Hermann AP, Tofteng CL, Bärenholdt O, et al. Discordance between changes in bone mineral density measured at different skeletal sites in perimenopausal women–implications for assessment of bone loss and response to therapy: the Danish Osteoporosis Prevention Study. J Bone Miner Res 2001;16:1212–19.10.1359/jbmr.2001.16.7.1212Search in Google Scholar PubMed
37. Gennari L, De Paola V, Merlotti D, Martini G, Nuti R. Steroid hormone receptor gene polymorphisms and osteoporosis: a pharmacogenomic review. Expert Opin Pharmacother 2007;8:537–53.10.1517/14656566.8.5.537Search in Google Scholar PubMed
38. Rietveld I, Janssen JA, van Rossum EF, Houwing-Duistermaat JJ, Rivadeneira F, et al. A polymorphic CA repeat in the IGF-I gene is associated with gender-specific differences in body height, but has no effect on the secular trend in body height. Clin Endocrinol 2004;61:195–03.10.1111/j.1365-2265.2004.02078.xSearch in Google Scholar PubMed
39. Rivadeneira F, Houwing-Duistermaat JJ, Vaessen N, Vergeer-Drop JM, Hofman A, et al. Association between an insulin-like growth factor I gene promoter polymorphism and bone mineral density in the elderly: the Rotterdam Study. J Clin Endocrinol Metab 2003;88:3878–84.10.1210/jc.2002-021813Search in Google Scholar PubMed
©2014 by De Gruyter
Articles in the same Issue
- Frontmatter
 - Highlight: Cushing syndrome
 - Fundamental principles of clinical and biochemical evaluation underlie the diagnosis and therapy of Cushing’s syndrome
 - Cushing syndrome secondary to CRH-producing Wilms tumor in a 6 year old
 - Cushing’s disease presenting as cholestatic hepatitis
 - How early can one diagnose Cushing’s disease? An early diagnosis in a case of prepubertal Cushing’s disease
 - Review article
 - Subclinical hypothyroidism in childhood and adolescense
 - Original articles
 - Energy substrate metabolism in pyruvate dehydrogenase complex deficiency
 - Chromosome 6q24 transient neonatal diabetes mellitus and protein sensitive hyperinsulinaemic hypoglycaemia
 - Measures of pituitary gland and stalk: from neonate to adolescence
 - Are preterm newborns who have relative hyperthyrotropinemia at increased risk of brain damage?
 - Pseudohypoparathyroidism vs. tricho-rhino-phalangeal syndrome: patient reclassification
 - Association of serum 25-hydroxyvitamin D with race/ethnicity and constitutive skin color in urban schoolchildren
 - A nonsense thyrotropin receptor gene mutation (R609X) is associated with congenital hypothyroidism and heart defects
 - Acanthosis nigricans, vitamin D, and insulin resistance in obese children and adolescents
 - Clinical characteristics and chromosome 11p15 imprinting analysis of Silver-Russell syndrome – a Chinese experience
 - Change in reference body mass index percentiles and deviation in overweight and obesity over 3 years in Turkish children and adolescents
 - Long-term outcomes of pediatric Graves’ disease
 - Accessibility of the reference center as a protective factor against ketoacidosis at the onset of diabetes in children
 - Vitamin D, parathormone, and insulin resistance in children born large for gestational age
 - Prevalence of vitamin D deficiency in apparently healthy children in north India
 - Prevalence of autoantibodies in type 1 diabetes patients and its association with the clinical presentation – UAE Eastern Region experience
 - Clinical and molecular studies related to bone metabolism in patients with congenital adrenal hyperplasia
 - Islet neogenesis-associated protein-related pentadecapeptide improves the function of allograft after islets transplantation
 - Anti-Mullerian hormone may be a useful adjunct in the diagnosis of polycystic ovary syndrome in nonobese adolescents
 - Early infant feeding practice and childhood obesity: the relation of breast-feeding and timing of solid food introduction with childhood obesity
 - Late onset X-linked adrenal hypoplasia congenita with hypogonadotropic hypgonadism due to a novel 4-bp deletion in exon 2 of NR0B1
 - The correlation between GnRH stimulation testing and obstetric ultrasonographic parameters in precocious puberty
 - The DATAC study: a new growth database. Description of the epidemiology, diagnosis and therapeutic attitude in a group of Spanish children with short stature
 - Concentrations of tumour necrosis factor-α and its soluble receptors in the serum of teenagers with atherosclerosis risk factors: obesity or obesity combined with hypertension
 - Are HDL levels lower in children with type 1 diabetes and concurrent celiac disease compared with children with type 1 diabetes only?
 - Patient reports
 - Hereditary vitamin D rickets: a case series in a family
 - Two heterozygous mutations of the AMH gene in a Japanese patient with persistent Müllerian duct syndrome
 - Two case reports of severe pediatric hyperosmolar hyperglycemia and diabetic ketoacidosis accompanied with rhabdomyolysis and acute renal failure
 - Acquired hypothyroidism due to iodine deficiency in an American child
 - Continuous subcutaneous IGF-1 therapy via insulin pump in a patient with Donohue syndrome
 - Amylase/creatinine clearance ratio in diabetic ketoacidosis: a case report
 - Worsening hypertriglyceridemia with oral contraceptive pills in an adolescent with HIV-associated lipodystrophy: a case report and review of the literature
 - Congenital hyperinsulinism in a newborn with a novel homozygous mutation (p.Q392H) in the ABCC8 gene
 - Short communications
 - Polyglandular autoimmune syndrome type I – a novel AIRE mutation in a North American patient
 - Post-hemorrhagic hydrocephalus and diabetes insipidus in preterm infants
 - Two novel mutations in acid α-glucosidase gene in two patients with Pompe disease
 - Letter to the Editor
 - And what about septin 9 (SEPT9) as a binding partner of survivin in heart regeneration?
 
Articles in the same Issue
- Frontmatter
 - Highlight: Cushing syndrome
 - Fundamental principles of clinical and biochemical evaluation underlie the diagnosis and therapy of Cushing’s syndrome
 - Cushing syndrome secondary to CRH-producing Wilms tumor in a 6 year old
 - Cushing’s disease presenting as cholestatic hepatitis
 - How early can one diagnose Cushing’s disease? An early diagnosis in a case of prepubertal Cushing’s disease
 - Review article
 - Subclinical hypothyroidism in childhood and adolescense
 - Original articles
 - Energy substrate metabolism in pyruvate dehydrogenase complex deficiency
 - Chromosome 6q24 transient neonatal diabetes mellitus and protein sensitive hyperinsulinaemic hypoglycaemia
 - Measures of pituitary gland and stalk: from neonate to adolescence
 - Are preterm newborns who have relative hyperthyrotropinemia at increased risk of brain damage?
 - Pseudohypoparathyroidism vs. tricho-rhino-phalangeal syndrome: patient reclassification
 - Association of serum 25-hydroxyvitamin D with race/ethnicity and constitutive skin color in urban schoolchildren
 - A nonsense thyrotropin receptor gene mutation (R609X) is associated with congenital hypothyroidism and heart defects
 - Acanthosis nigricans, vitamin D, and insulin resistance in obese children and adolescents
 - Clinical characteristics and chromosome 11p15 imprinting analysis of Silver-Russell syndrome – a Chinese experience
 - Change in reference body mass index percentiles and deviation in overweight and obesity over 3 years in Turkish children and adolescents
 - Long-term outcomes of pediatric Graves’ disease
 - Accessibility of the reference center as a protective factor against ketoacidosis at the onset of diabetes in children
 - Vitamin D, parathormone, and insulin resistance in children born large for gestational age
 - Prevalence of vitamin D deficiency in apparently healthy children in north India
 - Prevalence of autoantibodies in type 1 diabetes patients and its association with the clinical presentation – UAE Eastern Region experience
 - Clinical and molecular studies related to bone metabolism in patients with congenital adrenal hyperplasia
 - Islet neogenesis-associated protein-related pentadecapeptide improves the function of allograft after islets transplantation
 - Anti-Mullerian hormone may be a useful adjunct in the diagnosis of polycystic ovary syndrome in nonobese adolescents
 - Early infant feeding practice and childhood obesity: the relation of breast-feeding and timing of solid food introduction with childhood obesity
 - Late onset X-linked adrenal hypoplasia congenita with hypogonadotropic hypgonadism due to a novel 4-bp deletion in exon 2 of NR0B1
 - The correlation between GnRH stimulation testing and obstetric ultrasonographic parameters in precocious puberty
 - The DATAC study: a new growth database. Description of the epidemiology, diagnosis and therapeutic attitude in a group of Spanish children with short stature
 - Concentrations of tumour necrosis factor-α and its soluble receptors in the serum of teenagers with atherosclerosis risk factors: obesity or obesity combined with hypertension
 - Are HDL levels lower in children with type 1 diabetes and concurrent celiac disease compared with children with type 1 diabetes only?
 - Patient reports
 - Hereditary vitamin D rickets: a case series in a family
 - Two heterozygous mutations of the AMH gene in a Japanese patient with persistent Müllerian duct syndrome
 - Two case reports of severe pediatric hyperosmolar hyperglycemia and diabetic ketoacidosis accompanied with rhabdomyolysis and acute renal failure
 - Acquired hypothyroidism due to iodine deficiency in an American child
 - Continuous subcutaneous IGF-1 therapy via insulin pump in a patient with Donohue syndrome
 - Amylase/creatinine clearance ratio in diabetic ketoacidosis: a case report
 - Worsening hypertriglyceridemia with oral contraceptive pills in an adolescent with HIV-associated lipodystrophy: a case report and review of the literature
 - Congenital hyperinsulinism in a newborn with a novel homozygous mutation (p.Q392H) in the ABCC8 gene
 - Short communications
 - Polyglandular autoimmune syndrome type I – a novel AIRE mutation in a North American patient
 - Post-hemorrhagic hydrocephalus and diabetes insipidus in preterm infants
 - Two novel mutations in acid α-glucosidase gene in two patients with Pompe disease
 - Letter to the Editor
 - And what about septin 9 (SEPT9) as a binding partner of survivin in heart regeneration?