Mineralna gustoća kosti i biljezi koštane pregradnje u bolesnika sa somatotropinomom [Bone mineral density and bone turnover markers in patients with somatotropinoma]

Dušek, Tina (2010) Mineralna gustoća kosti i biljezi koštane pregradnje u bolesnika sa somatotropinomom [Bone mineral density and bone turnover markers in patients with somatotropinoma]. PhD thesis, Sveučilište u Zagrebu.

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Abstract

The aim of this study was to investigate the bone mineral density in patients with hypersecretion of growth hormone caused by somatotropinoma, as well as to measure the bone turnover markers before and 6 months after the treatment of disease. Additional purpose of the study was to detect the prevalence of comorbidities in patients with acromegaly and to evaluate the results of the acromegaly treatment. The study comprised 53 patients diagnosed and treated for acromegaly at Division of Endocrinology, University Hospital Centre Zagreb in the period from year 2000 to 2010. Analysis of bone mineral density was done by DXA (n=43 patients) and by quantitative ultrasound of the heel (n=36 patients). Bone turnover markers were analysed before the acromegaly treatment (n=37 patients) and six months after the disease remission achievement (n=28 patients). Bone turnover markers were significantly higher in patients with acromegaly than in the control group (osteocalcin, p=0,003; bone alkaline phosphatase, p<0,001; β-crosslaps, p<0,001). Six moths after the disease remission achievement osteocalcin and β-crosslaps levels significantly decreased (p<0.05), whilst the reduction in alkaline phosphatase level was not statistically significant. When patients with disease remission were compared to control group, bone alkaline phosphatase and β-crosslaps were still significantly higher in patients (p<0.05). The osteocalcin level did not differ significantly between the two groups. Female patients had significantly higher bone mineral density in femoral neck and trochanter region when compared to controls. No significant differences were found between bone mineral density of male patients with acromegaly and controls. The results imply the important effect of growth hormone on bone turnover which can still be observed six months after normalisation of growth hormone and IGF-I secretion.

Abstract in Croatian

Cilj ovog istraživanja bio je ispitivanje mineralne gustoće kosti u bolesnika s prekomjernim lučenjem hormona rasta, te prospektivno praćenje vrijednosti biljega koštane pregradnje prije i nakon izlječenja bolesti. Dodatni cilj istraživanja bio je praćenje pridruženih bolesti i uspjeha liječenja tih bolesnika. U istraživanje je uključeno 53 bolesnika liječenih u Zavodu za endokrinologiju KBC Zagreb zbog prekomjernog lučenja hormona rasta uzrokovanog somatotropinomom u periodu od 2000. do 2010. godine. U cilju procjene mineralne gustoće i metabolizma kosti ispitanicima je učinjeno mjerenje mineralne gustoće kosti pomoću DXA (n=43 ispitanika) i kvantitativnog ultrazvuka petne kosti (n=36 ispitanika) te mjerenje biljega koštane pregradnje (osteokalcin, koštana alkalna fosfataza, β-crosslaps) prije početka liječenja (n=37 ispitanika) i 6 mjeseci nakon postizanja remisije bolesti (n=28 ispitanika). U bolesnika s akromegalijom su nađene statistički značajno više vrijednosti biljega koštane pregradnje nego u zdravih pojedinaca (osteokalcin: p=0,003; koštana alkalna fosfataza: p<0,001; β-crosslaps: p<0,001). Šest mjeseci nakon postizanja remisije bolesti došlo je do značajnog smanjenja koncentracije osteokalcina i β-crosslaps, dok smanjenje aktivnosti alkalne fosfataze nije doseglo razinu statističke značajnosti. U usporedbi sa zdravom populacijom, 6 mjeseci nakon postizanja remisije bolesti koncentracije β-crosslaps i aktivnost koštane alkalne fosfataze i dalje su bili značajno viši u skupini bolesnika (p<0,05), dok se koncentracije osteokalcina nisu značajno razlikovale među te dvije skupine. Bolesnice su imale značajno višu mineralnu gustoću kosti u području vrata i trohantera bedrene kosti u usporedbi s kontrolnom skupinom. Mineralna gustoća kosti muških bolesnika nije se razlikovala od zdravih pojedinaca, dok su parametri kvantitativnog ultrazvuka petne kosti bili značajno niži u skupini bolesnika nego u kontrolnoj skupini. Rezultati upućuju na značajnu ulogu hormona rasta na ubrzanje koštane pregradnje što se očituje i 6 mjeseci nakon postizanja remisije bolesti.

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