Abstract
The spontaneous or therapeutically induced pubertal development of 65 male patients with idiopathic hypopituitarism was analysed. Spontaneous puberty occurred in 82% of the patients with prepubertal isolated growth hormone deficiency and in 32.5% of those with impairment in the secretion of more than one pituitary hormone.
Out of this group, 36 patients could be studied longitudinally. In 15 patients, the onset of spontaneous puberty was delayed, on average, 3.2 years. It started at a bone age of 10.36±1.25 “years” and followed a pattern similar to that of normal boys. Testosterone levels at each pubertal stage were not different from those of normal boys. Mean peak height velocity reached 7.27±1.82 cm/year. In 21 patients with gonadotropin deficiency, hCG treatment was started at a chronological age of 19.04±2.17 years and a bone age of 12.94±0.80 “years”. Plasma testosterone attained normal adult levels in the majority of boys, while the development of sexual characteristics showed a wide variation. Mean growth velocity during the first year of hCG therapy reached 6.11±2.47 cm/year. Partial gonadotropin deficiency was diagnosed in two boys.
Although testosterone seems today to be, for practical reasons, the replacement therapy of choice, hCG treatment is an alternative for hypopituitary patients with absent gonadotropin function.
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Abbreviations
- IGHD:
-
isolated growth hormone deficiency
- MPHD:
-
multiple pituitary hormone deficiency
- hCG:
-
human chorionic gonadotropin
- hGH:
-
human growth hormone
- PHV:
-
peak height velocity
References
Aynsley-Green A, Zachmann M, Prader A (1976) Interrelation of the therapeutic effects of growth hormone and testosterone on growth in hypopituitarism. J Pediatr 89 (6):992–999
Bourguignon JP, Vanderschueren-Lodeweyckx M, Wolter R, Malvaux P, Craen M, Du Caju MVL, Ernould C, Franchimont P (1982) Hypopituitarism and idiopathic delayed puberty: a longitudinal study in an attempt to diagnose gonadotropin deficiency before puberty. J Clin Endocrinol Metab 54 (4):733–744
Brasel JA, Wright JC, Wilkins L, Blizzard RM (1965) An evaluation of seventy-five patients with hypopituitarism beginning in childhood. Am J Med 38 (4):484–498
Burns EC, Tanner JM, Preece MA, Cameron N (1981) Final height and pubertal development in 55 children with idiopathic growth hormone deficiency, treated for between 2 and 15 years with human growth hormone. Eur J Pediatr 137:155–164
Burns EC, Tanner JM, Preece MA, Cameron M (1981) Growth hormone treatment in children with craneopharyngioma: final growth status. Clin Endocrinol (Oxf) 14:587–595
Ernould Chr, Bourguignon JP, Lambrechts L, Craen M, Du Caju M, Malvaux P, Van Vliet G, Wolter R, Vanderschueren-Lodeweyckx M (1980) Effects of spontaneous and testosterone-induced puberty on height velocity, bone maturation and pubertal development in boys with hypopituitarism during human growth hormone therapy. In: Cacciari E, Prader A (eds) Pathophysiology of puberty. Academic Press, London New York, pp 315–321
Goodman HG, Grumbach MM, Kaplan SL (1968) Growth and growth hormone. II. A comparison of isolated growth hormone deficiency and multiple pituitary hormone deficiencies in 35 patients with idiopathic hypopituitary dwarfism. N Engl J Med 278 (2):57–68
Greulich WW, Pyle SI (1959) Radiographic atlas of skeletal development of the hand and wrist. Stanford University Press, Stanford, California
Hoffman AR, Crowley WJ Jr (1982) Induction of puberty in men by long-term pulsatile administration of low dose gonadotropinreleasing hormone. N Engl J Med 307 (2):1237–1241
Kulin HE, Eugeniusz Samojlik, Santen R, Santner S (1981) The effect of growth hormone on the Leydig cell response to chorionic gonadotrophin in boys with hypopituitarism. Clin Endocrinol (Oxf) 15:463–472
Laron Z, Sarel R, Hochberg Z, Pertzelan A (1980) Puberty in Laron type dwarfism. In: Cacciari E, Prader A (eds) Pathophysiology of puberty. Academic Press, London New York, pp 197–206
Lejarraga H, Cusminsky M, Castro EP (1976) Age of onset of puberty in urban Argentinian children. Ann Hum Biol 3:379–381
Marshall WA, Tanner JM (1970) Variations in the pattern of pubertal changes in boys. Arch Dis Child 45:13–23
Mills JD, Ashworth RB, Willhelmi AE, Hartree AS (1969) Improved method for the extraction and purification of human growth hormone. J Clin Endocrinol Metab 29:1456–1459
Rabinowitz D, Merimee TJ (1973) Isolated human growth hormone deficiency and related disorders. Isr J Med Sci 9 (11–12):1601–1652
Rivarola MA, Heinrich JJ, Podestá EJ, de Chwojnik MF, Bergadá C (1972) Testicular function in hypopituitarism. Pediatr Res 6:634–640
Roos P, Fevold HR, Gemzell CA (1963) Preparation of human growth hormone by gel filtration. Biochem Biophys Acta 74:525–531
Tanner JM (1962) Growth at adolescence, 2nd edn. Blackwell Scientific Publications, Oxford
Tanner JM, Whitehouse RH (1975) A note on the bone age at which patients with true isolated growth hormone deficiency enter puberty. J Clin Endocrinol Metab 41 (4):788–790
Tanner JM, Whitehouse RH, Takaishi M (1965) Standards from birth to maturity for height, weight, height velocity and weight velocity: British children. Arch Dis Child 41:454–471
Tanner JM, Whitehouse RH, Hughes PCR, Carter BS (1976) Relative importance of growth hormone and sex steroids for the growth at puberty of trunk length, limb length and muscle width in growth hormone deficient children. J Pediatr 89 (6):1000–1008
Zachmann M, Prader A (1970) Anabolic and androgenic effect of testosterone in sexually immature boys and its dependency on growth hormone. J Clin Endocrinol Metab 30:85–95
Zachmann M, Prader A, Kind HP, Haflinger H, Budliger H (1964) Testicular volume during adolescence. Helv Pediatr Acta 29:61–72
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Martínez, A.S., Heinrich, J.J., Rivarola, M.A. et al. Pubertal development in male hypopituitarism. Eur J Pediatr 145, 384–388 (1986). https://doi.org/10.1007/BF00439244
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DOI: https://doi.org/10.1007/BF00439244