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NDT Plus Advance Access published online on July 6, 2009
NDT Plus, doi:10.1093/ndtplus/sfp082
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© The Author [2009]. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org

Polymorphisms of the glucocorticoid receptor and avascular necrosis of the femoral heads after treatment with corticosteroids

Rachida Bouamar1, Jan Willem Koper2, Elisabeth F. C. van Rossum2, Willem Weimar2 and Teun van Gelder1,2

1 Departments of Hospital Pharmacy
2 Internal Medicine, Erasmus Medical Center, Rotterdam, The Netherlands

Correspondence: Rachida Bouamar; E-mail: r.bouamar{at}erasmusmc.nl


  Abstract

A female patient developed avascular necrosis of the femoral heads after receiving low doses of glucocorticosteroids (GC) for 3 months. Genotyping of the GC receptor (GR) showed that she was heterozygous for the Bcl-1 allele and heterozygous for the N363S allele. Interestingly, these GR variants are both associated with higher sensitivity to glucocorticoids. It is not known whether the GR gene polymorphisms are causally related to osteonecrosis. However, the presence of these GR variants, as a combination present in only 1% of the normal Caucasian population, seems suggestive. Studies are warranted to investigate the importance of polymorphisms related to GC sensitivity.

Key Words: avascular necrosis • glucocorticoid receptor • glucocorticosteroids • polymorphism

Received for publication May 12, 2009. Accepted for publication June 16, 2009.


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