Osteocalcin in the serum reflects bone turnover. It is known that prolonged therapy with glucocorticoids inhibits bone turnover. The aim of this study was to evaluate the osteocalcin level in children with congenital adrenal hyperplasia treated by glucocorticoids and mineralocorticoids and to assess the influence of 1,25(OH)2D3. The subjects were 75 children with congenital adrenal hyperplasia, aged 1-18 years, treated with glucocorticoids and mineralocorticoids in substitution doses from birth. These children demonstrated low levels of osteocalcin and alkaline phosphatase, whereas calcium and phosphate were in the normal ranges. Despite these abnormalities, no osteoporosis was detectable and a normal growth rate was confirmed, most probably because of higher levels of androgens; 17-OH progesterone averaged 11.8 nmol/l. After treatment with 1,25(OH)2D3, the osteocalcin levels increased, followed later by increases of alkaline phosphatase and bone isoenzyme.
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