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Mazziotti G, Mormando M, Cristiano A, Bianchi A, Porcelli T, Giampietro A, Maffezzoni F, Serra V, De Marinis L, Giustina A. Association between l-thyroxine treatment, GH deficiency, and radiological vertebral fractures in patients with adult-onset hypopituitarism. Eur J Endocrinol 2014; 170:893-9. [PMID: 24836549 DOI: 10.1530/eje-14-0097] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE 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.
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Affiliation(s)
- G Mazziotti
- Chair of EndocrinologyUniversity of Brescia, A.O. Spedali Civili di Brescia, 25123 Brescia, ItalyPituitary UnitDepartment of Endocrinology, Catholic University of Rome, 00168 Rome, Italy
| | - M Mormando
- Chair of EndocrinologyUniversity of Brescia, A.O. Spedali Civili di Brescia, 25123 Brescia, ItalyPituitary UnitDepartment of Endocrinology, Catholic University of Rome, 00168 Rome, Italy
| | - A Cristiano
- Chair of EndocrinologyUniversity of Brescia, A.O. Spedali Civili di Brescia, 25123 Brescia, ItalyPituitary UnitDepartment of Endocrinology, Catholic University of Rome, 00168 Rome, Italy
| | - A Bianchi
- Chair of EndocrinologyUniversity of Brescia, A.O. Spedali Civili di Brescia, 25123 Brescia, ItalyPituitary UnitDepartment of Endocrinology, Catholic University of Rome, 00168 Rome, Italy
| | - T Porcelli
- Chair of EndocrinologyUniversity of Brescia, A.O. Spedali Civili di Brescia, 25123 Brescia, ItalyPituitary UnitDepartment of Endocrinology, Catholic University of Rome, 00168 Rome, Italy
| | - A Giampietro
- Chair of EndocrinologyUniversity of Brescia, A.O. Spedali Civili di Brescia, 25123 Brescia, ItalyPituitary UnitDepartment of Endocrinology, Catholic University of Rome, 00168 Rome, Italy
| | - F Maffezzoni
- Chair of EndocrinologyUniversity of Brescia, A.O. Spedali Civili di Brescia, 25123 Brescia, ItalyPituitary UnitDepartment of Endocrinology, Catholic University of Rome, 00168 Rome, Italy
| | - V Serra
- Chair of EndocrinologyUniversity of Brescia, A.O. Spedali Civili di Brescia, 25123 Brescia, ItalyPituitary UnitDepartment of Endocrinology, Catholic University of Rome, 00168 Rome, Italy
| | - L De Marinis
- Chair of EndocrinologyUniversity of Brescia, A.O. Spedali Civili di Brescia, 25123 Brescia, ItalyPituitary UnitDepartment of Endocrinology, Catholic University of Rome, 00168 Rome, Italy
| | - A Giustina
- Chair of EndocrinologyUniversity of Brescia, A.O. Spedali Civili di Brescia, 25123 Brescia, ItalyPituitary UnitDepartment of Endocrinology, Catholic University of Rome, 00168 Rome, Italy
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