The contribution of serum cortisone and glucocorticoid metabolites to detrimental bone health in patients receiving hydrocortisone therapy
Abstract Background Glucocorticoid therapy is the most common cause of iatrogenic osteoporosis. Less is known regarding the effect of glucocorticoids when used as replacement therapy on bone remodelling in patients with adrenal insufficiency. Enhanced intracellular conversion of inactive cortisone t...
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| Format: | Article |
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BMC
2020-10-01
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| Series: | BMC Endocrine Disorders |
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| Online Access: | http://link.springer.com/article/10.1186/s12902-020-00633-1 |
| _version_ | 1818199085897744384 |
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| author | Rosemary Dineen Lucy-Ann Behan Grainne Kelleher Mark J. Hannon Jennifer J. Brady Bairbre Rogers Brian G. Keevil William Tormey Diarmuid Smith Christopher J. Thompson Malachi J. McKenna Wiebke Arlt Paul M. Stewart Amar Agha Mark Sherlock |
| author_facet | Rosemary Dineen Lucy-Ann Behan Grainne Kelleher Mark J. Hannon Jennifer J. Brady Bairbre Rogers Brian G. Keevil William Tormey Diarmuid Smith Christopher J. Thompson Malachi J. McKenna Wiebke Arlt Paul M. Stewart Amar Agha Mark Sherlock |
| author_sort | Rosemary Dineen |
| collection | DOAJ |
| description | Abstract Background Glucocorticoid therapy is the most common cause of iatrogenic osteoporosis. Less is known regarding the effect of glucocorticoids when used as replacement therapy on bone remodelling in patients with adrenal insufficiency. Enhanced intracellular conversion of inactive cortisone to active cortisol, by 11 beta-hydroxysteroid dehydrogenase type 1(11β-HSD1) and other enzymes leading to alterations in glucocorticoid metabolism, may contribute to a deleterious effect on bone health in this patient group. Methods Study design: An open crossover prospective study randomizing ten hypopituitary men, with severe ACTH deficiency, to three commonly used hydrocortisone dose regimens. Measurements: Following 6 weeks of each regimen, patients underwent 24-h serum cortisol/cortisone sampling, measurement of bone turnover markers, and a 24-h urine collection for measurement of urinary steroid metabolites by gas chromatography-mass spectrometry (GC-MS). Serum cortisone and cortisol were analysed by liquid chromatography-mass spectrometry (LC-MS). Results Dose-related and circadian variations in serum cortisone were seen to parallel those for cortisol, indicating conversion of ingested hydrocortisone to cortisone. The median area under the curve (AUC) of serum cortisone was significantly higher in patients on dose A (20 mg/10 mg) [670.5 (IQR 621–809.2)] compared to those on dose C (10 mg/5 mg) [562.8 (IQR 520.1–619.6), p = 0.01]. A negative correlation was observed between serum cortisone and bone formation markers, OC [1–49] (r = − 0.42, p = 0.03), and PINP (r = − 0.49, p = 0.01). There was a negative correlation between the AUC of night-time serum cortisone levels with the bone formation marker, OC [1–49] (r = − 0.41, p = 0.03) but there were no significant correlations between day-time serum cortisone or cortisol with bone turnover markers. There was a negative correlation between total urinary cortisol metabolites and the bone formation markers, PINP (r = − 0.39, p = 0.04), and OC [1–49] (r = − 0.35, p = 0.06). Conclusion Serum cortisol and cortisone and total urinary corticosteroid metabolites are negatively associated with bone turnover markers in patients receiving replacement doses of hydrocortisone, with nocturnal glucocorticoid exposure having a potentially greater influence on bone turnover. Trial registration Irish Medicines Board Clinical Trial Number – CT900/459/1 and EudraCT Number – 2007-005018-37 . Registration date: 07-09-2007. |
| first_indexed | 2024-12-12T02:16:10Z |
| format | Article |
| id | doaj.art-bf4aba1aa7d2468da0919f529f545f18 |
| institution | Directory Open Access Journal |
| issn | 1472-6823 |
| language | English |
| last_indexed | 2024-12-12T02:16:10Z |
| publishDate | 2020-10-01 |
| publisher | BMC |
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| series | BMC Endocrine Disorders |
| spelling | doaj.art-bf4aba1aa7d2468da0919f529f545f182022-12-22T00:41:48ZengBMCBMC Endocrine Disorders1472-68232020-10-0120111310.1186/s12902-020-00633-1The contribution of serum cortisone and glucocorticoid metabolites to detrimental bone health in patients receiving hydrocortisone therapyRosemary Dineen0Lucy-Ann Behan1Grainne Kelleher2Mark J. Hannon3Jennifer J. Brady4Bairbre Rogers5Brian G. Keevil6William Tormey7Diarmuid Smith8Christopher J. Thompson9Malachi J. McKenna10Wiebke Arlt11Paul M. Stewart12Amar Agha13Mark Sherlock14Department of Endocrinology, Tallaght University HospitalDepartment of Endocrinology, Tallaght University HospitalDepartment of Chemical Pathology, Beaumont HospitalAcademic Department of Endocrinology, Beaumont Hospital and Royal College of Surgeons in IrelandMetabolism Laboratory, St Vincent’s University HospitalAcademic Department of Endocrinology, Beaumont Hospital and Royal College of Surgeons in IrelandManchester Academic Health Science Centre, University Hospital of South Manchester, The University of ManchesterDepartment of Chemical Pathology, Beaumont HospitalAcademic Department of Endocrinology, Beaumont Hospital and Royal College of Surgeons in IrelandAcademic Department of Endocrinology, Beaumont Hospital and Royal College of Surgeons in IrelandMetabolism Laboratory, St Vincent’s University HospitalInstitute of Metabolism and Systems Research, University of BirminghamMedical School, University of LeedsAcademic Department of Endocrinology, Beaumont Hospital and Royal College of Surgeons in IrelandAcademic Department of Endocrinology, Beaumont Hospital and Royal College of Surgeons in IrelandAbstract Background Glucocorticoid therapy is the most common cause of iatrogenic osteoporosis. Less is known regarding the effect of glucocorticoids when used as replacement therapy on bone remodelling in patients with adrenal insufficiency. Enhanced intracellular conversion of inactive cortisone to active cortisol, by 11 beta-hydroxysteroid dehydrogenase type 1(11β-HSD1) and other enzymes leading to alterations in glucocorticoid metabolism, may contribute to a deleterious effect on bone health in this patient group. Methods Study design: An open crossover prospective study randomizing ten hypopituitary men, with severe ACTH deficiency, to three commonly used hydrocortisone dose regimens. Measurements: Following 6 weeks of each regimen, patients underwent 24-h serum cortisol/cortisone sampling, measurement of bone turnover markers, and a 24-h urine collection for measurement of urinary steroid metabolites by gas chromatography-mass spectrometry (GC-MS). Serum cortisone and cortisol were analysed by liquid chromatography-mass spectrometry (LC-MS). Results Dose-related and circadian variations in serum cortisone were seen to parallel those for cortisol, indicating conversion of ingested hydrocortisone to cortisone. The median area under the curve (AUC) of serum cortisone was significantly higher in patients on dose A (20 mg/10 mg) [670.5 (IQR 621–809.2)] compared to those on dose C (10 mg/5 mg) [562.8 (IQR 520.1–619.6), p = 0.01]. A negative correlation was observed between serum cortisone and bone formation markers, OC [1–49] (r = − 0.42, p = 0.03), and PINP (r = − 0.49, p = 0.01). There was a negative correlation between the AUC of night-time serum cortisone levels with the bone formation marker, OC [1–49] (r = − 0.41, p = 0.03) but there were no significant correlations between day-time serum cortisone or cortisol with bone turnover markers. There was a negative correlation between total urinary cortisol metabolites and the bone formation markers, PINP (r = − 0.39, p = 0.04), and OC [1–49] (r = − 0.35, p = 0.06). Conclusion Serum cortisol and cortisone and total urinary corticosteroid metabolites are negatively associated with bone turnover markers in patients receiving replacement doses of hydrocortisone, with nocturnal glucocorticoid exposure having a potentially greater influence on bone turnover. Trial registration Irish Medicines Board Clinical Trial Number – CT900/459/1 and EudraCT Number – 2007-005018-37 . Registration date: 07-09-2007.http://link.springer.com/article/10.1186/s12902-020-00633-1CortisoneCortisolBone turnover markersHypopituitarismMetabolitesAdrenal insufficiency |
| spellingShingle | Rosemary Dineen Lucy-Ann Behan Grainne Kelleher Mark J. Hannon Jennifer J. Brady Bairbre Rogers Brian G. Keevil William Tormey Diarmuid Smith Christopher J. Thompson Malachi J. McKenna Wiebke Arlt Paul M. Stewart Amar Agha Mark Sherlock The contribution of serum cortisone and glucocorticoid metabolites to detrimental bone health in patients receiving hydrocortisone therapy BMC Endocrine Disorders Cortisone Cortisol Bone turnover markers Hypopituitarism Metabolites Adrenal insufficiency |
| title | The contribution of serum cortisone and glucocorticoid metabolites to detrimental bone health in patients receiving hydrocortisone therapy |
| title_full | The contribution of serum cortisone and glucocorticoid metabolites to detrimental bone health in patients receiving hydrocortisone therapy |
| title_fullStr | The contribution of serum cortisone and glucocorticoid metabolites to detrimental bone health in patients receiving hydrocortisone therapy |
| title_full_unstemmed | The contribution of serum cortisone and glucocorticoid metabolites to detrimental bone health in patients receiving hydrocortisone therapy |
| title_short | The contribution of serum cortisone and glucocorticoid metabolites to detrimental bone health in patients receiving hydrocortisone therapy |
| title_sort | contribution of serum cortisone and glucocorticoid metabolites to detrimental bone health in patients receiving hydrocortisone therapy |
| topic | Cortisone Cortisol Bone turnover markers Hypopituitarism Metabolites Adrenal insufficiency |
| url | http://link.springer.com/article/10.1186/s12902-020-00633-1 |
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