ometendoОжирение и метаболизмObesity and metabolism2071-87132306-5524Endocrinology Research Centre10.14341/omet12700ometendo-12700Research ArticleОбзор литературыReviewВлияние заместительной терапии глюкокортикоидами на костный обмен при надпочечниковой недостаточности. Обзор литературыEffect of glucocorticoids on bone metabolism in replacement therapy of adrenal insufficiency. Literature reviewhttps://orcid.org/0000-0002-8771-8300ЮкинаМ. Ю.YukinaM. Yu.

Юкина Марина Юрьевна, кандидат медицинских наук

117036, Москва, ул. Дм. Ульянова, д. 11

eLibrary SPIN: 4963-8340

Marina Yu. Yukina, MD, PhD

11 Dm. Ulyanova street, 117036 Moscow

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kuronova@yandex.ruЧерноваМ. О.ChernovaM. O.

Чернова Мария Олеговна, ординатор

Москва

Maria O. Chernova, MD, resident

Moscow

maryblack22@mail.ruhttps://orcid.org/0000-0001-6876-3336НуралиеваН. Ф.NuralievaN. F.

Нуралиева Нурана Фейзуллаевна

Москва

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Nurana F. Nuralieva, MD

Moscow

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dr.nuralievanf@yandex.ruhttps://orcid.org/0000-0001-6667-062XЕремкинаА. К.EremkinaA. K.

Еремкина Анна Константиновна, кандидат медицинских наук

Москва

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Anna K. Eremkina, MD, PhD

Moscow

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a.lipatenkova@gmail.comhttps://orcid.org/0000-0002-8520-8702ТрошинаЕ. А.TroshinaE. A.

Трошина Екатерина Анатольевна, доктор медицинских наук, профессор

Москва

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Ekaterina A. Troshina, MD, PhD, professor

Moscow

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troshina@inbox.ruhttps://orcid.org/0000-0002-5634-7877МельниченкоГ. А.MelnichenkoG. A.

Мельниченко Галина Афанасьевна, доктор медицинских наук, профессор

Москва

eLibrary SPIN: 8615-0038

Galina A. Melnichenko, MD, PhD, professor

Moscow

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teofrast2000@mail.ruhttps://orcid.org/0000-0002-9258-2591МокрышеваН. Г.MokryshevaN. G.

Мокрышева Наталья Георгиевна, доктор медицинских наук, профессор

Москва

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Natalia G. Mokrysheva, MD, PhD, professor

Moscow

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parathyroid.enc@gmail.comНациональный медицинский исследовательский центр эндокринологииEndocrinology Research Centre202025122020174357368Copyright © Юкина М.Ю., Чернова М.О., Нуралиева Н.Ф., Еремкина А.К., Трошина Е.А., Мельниченко Г.А., Мокрышева Н.Г., 20202020Юкина М.Ю., Чернова М.О., Нуралиева Н.Ф., Еремкина А.К., Трошина Е.А., Мельниченко Г.А., Мокрышева Н.Г.Yukina M.Y., Chernova M.O., Nuralieva N.F., Eremkina A.K., Troshina E.A., Melnichenko G.A., Mokrysheva N.G.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.omet-endojournals.ru/jour/article/view/12700

Надпочечниковая недостаточность — синдром, обусловленный нарушением синтеза и секреции гормонов коры надпочечников, которые обеспечивают жизнедеятельность организма, энергетический и водно-солевой гомеостаз. Наиболее широкий гормональный дефицит отмечается при первичном гипокортицизме, когда наблюдается снижение не только уровней глюкокортикоидов (ГК) и надпочечниковых андрогенов, но и нарушение синтеза минералокортикоидов. Пожизненная заместительная терапия препаратами ГК при данной патологии может быть ассоциирована с риском потери костной массы и развитием остеопороза. Однако в настоящее время не разработаны четкие рекомендации по необходимости мониторинга минеральной плотности костной ткани на фоне лечения ГК у пациентов с надпочечниковой недостаточностью. В обзоре проводится анализ данных мировой литературы о ключевых патогенетических звеньях глюкокортикоид-индуцированного остеопороза, частоте снижения минеральной плотности кости и возникновения переломов у пациентов с гипокортицизмом, рассматриваются факторы, которые оказывают влияние на костный обмен у данной когорты больных: форма и доза назначаемого ГК, вариант (первичная, вторичная, надпочечниковая недостаточность при врожденной дисфункции коры надпочечников) и длительность гипокортицизма, возраст, пол, наличие сопутствующих эндокринных нарушений (гипогонадизм, недостаточность гормона роста). Обсуждаются результаты исследований, оценивающих состояние костного метаболизма при коррекции дефицита надпочечниковых андрогенов и терапии рекомбинантным гормоном роста при вторичной надпочечниковой недостаточности.

Adrenal insufficiency (AI) is a syndrome caused by disturbance in the synthesis and secretion of hormones of the adrenal cortex, which ensure the vital activity, energy and water-salt homeostasis. The widest hormonal deficiency is observed in primary hypocorticism, when the synthesis of not only glucocorticoids (GC) and adrenal androgens, but also mineralocorticoids is disrupted. Lifelong replacement therapy with GCs for this pathology may be associated with a risk of bone loss and osteoporosis. However, at present, there are no clear guidelines for diagnosis of bone condition, including and bone mineral density (BMD) monitoring during treatment with GCs in patients with AI. This review summarizes collected data on the key pathogenetic links of glucocorticoid-induced osteoporosis, incidence of decreased BMD and fractures in patients with AI. In this review factors that influence bone metabolism in this cohort of patients are considered: the type and the dose of prescribed GCs, the type (primary, secondary, HH in congenital adrenal cortex dysfunction) and the duration of AI, age, gender, and the presence of concomitant endocrine disorders (hypogonadism, growth hormone (GH) deficiency). In addition, the review presents data on the effect of adrenal androgen replacement therapy and recombinant GH therapy on bone metabolism in secondary AI.

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The authors declare that there are no conflicts of interest present.