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Association between l-thyroxine treatment, GH deficiency, and radiological vertebral fractures in patients with adult-onset hypopituitarism.

AbstractOBJECTIVE:
In this study, we aimed at evaluating the association between radiological vertebral fractures and levo-thyroxine (l-T4) replacement doses in adult patients with hypopituitarism.
DESIGN:
Cross-sectional study.
METHODS:
We studied 74 adult hypopituitary patients (males, 43; females, 31; mean age, 57 years; and range, 23-79) with central hypothyroidism treated with l-T4 (median daily dose: 1.1  μg/kg). All patients also had severe GH deficiency (GHD) and 38 of them were replaced with recombinant GH. Vertebral fractures were assessed by a quantitative morphometric analysis performed on thoracic and lumbar spine lateral X-ray.
RESULTS:
Radiological vertebral fractures were found in 23 patients (31.1%) in association with untreated GHD (P=0.02), higher serum free T4 levels (P=0.03), a higher daily dose of l-T4 (P=0.005), and a longer duration of hypopituitarism (P=0.05). When GHD was treated, the prevalence of vertebral fractures was more frequent (P=0.03) in patients receiving high l-T4 doses (third tertile: >1.35  μg/kg per day) as compared with patients who were treated with lower drug doses (first tertile: <0.93  μg/kg per day). Such a difference was not observed in patients with untreated GHD who showed a higher prevalence of vertebral fractures regardless of l-T4 daily doses. Multivariate analysis showed that untreated GHD (odds ratio: 4.27, 95% CI 1.27-14.33; P=0.01) and the daily dose of l-T4 (odds ratio: 4.01, 95% CI 1.16-14.39; P=0.03) maintained a significant and independent association with vertebral fractures in patients with central hypothyroidism.
CONCLUSIONS:
Our data suggest for the first time that a relative overtreatment with l-T4 may influence the fracture risk in some patients with hypopituitarism.
AuthorsG Mazziotti, M Mormando, A Cristiano, A Bianchi, T Porcelli, A Giampietro, F Maffezzoni, V Serra, L De Marinis, A Giustina
JournalEuropean journal of endocrinology (Eur J Endocrinol) Vol. 170 Issue 6 Pg. 893-9 (Jun 2014) ISSN: 1479-683X [Electronic] England
PMID24836549 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)
Copyright© 2014 European Society of Endocrinology.
Chemical References
  • Human Growth Hormone
  • Thyroxine
Topics
  • Adult
  • Age of Onset
  • Aged
  • Cross-Sectional Studies
  • Female
  • Hormone Replacement Therapy (statistics & numerical data)
  • Human Growth Hormone (deficiency)
  • Humans
  • Hypopituitarism (complications, diagnostic imaging, drug therapy, epidemiology)
  • Male
  • Middle Aged
  • Prevalence
  • Radiography
  • Spinal Fractures (complications, diagnostic imaging, epidemiology)
  • Thyroxine (therapeutic use)
  • Young Adult

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