Long Term Follow-Up of One of The First Patients to Receive Human Growth Hormone Therapy

Abstract

Objective: Treatment of growth hormone (GH) deficiency with GH extracts from human pituitary glands was introduced by Dr. Maurice Raben at Tufts New England Medical Center in 1956. We report long term follow-up of one of the first patients treated with GH. Methods: Clinical, radiographic and genetic data are presented. Results: A 78-year-old man presented for follow-up. He was one of the first patients to receive GH therapy from Raben in 1958. Growth was reported as normal until age 3 and then decelerated. At age 17, he was 129.5 cm with absent sexual development and bone age of 7. Treatment was initiated with desiccated thyroid and cortisone acetate for 8 months. Human GH extract was then initiated with 2 mg 3 times/week for 2 years, then 3 mg 3 times/week for 6 months resulting in final height of 168.9 cm. Testosterone intramuscularly every 2 weeks was added with sexual maturation over 2 years. He remained on testosterone injections until age 40, and transdermal testosterone until age 50. At age 27, he was treated by Raben with human chorionic gonadotropin and menotropins for spermatogenesis restoration with successful conception by wife. At age 78, pituitary MRI revealed a tiny amount of pituitary tissue within normal-sized sella turcica with absent pituitary infundibulum. A combined pituitary hormone deficiency genetic panel did not reveal any mutations. Conclusion: 62 years later, patient remains in good health and grateful to a pioneer in Endocrinology for groundbreaking therapy of short stature. The cause of his hypopituitarism remains unknown.

Human Growth and Growth Hormone: From Antiquity to the Recominant Age to the Future

“…In a remarkable 60 y follow-up one of Raben’s original patients was re-evaluated at age 78 y. He received hGH (Raben preparation) in 1956 at age 17 y at which time he was 129.5 cm, had no sexual development and a bone age of 7 yr. Two and one half years of hGH led to an adult height of 168.9 cm or 15.5 cm/y during those 21/2 y ( 50 ). He was subsequently treated with thyroid hormone, cortisone acetate, and testosterone.…”

“…MRI examination of the brain at 78 y revealed a tiny pituitary with absent infundibulum. Combined pituitary deficiency genetic panel did not reveal any clinically relevant variant and serum levels of GH, FSH, LH, and testosterone were undetectable ( 50 ). In addition in a tantalizing short paragraph titled: Treatment of adult hypopituitarism Raben noted that an adult woman with hypopituitarism had been fully treated with the agents available at that time-thyroid, ACTH and estrogen, but was not completely “well”.…”

Growth Hormone Gene Family and Its Evolution

“…This pioneer treatment was introduced by Dr. Maurice Raben at Tufts New England Medical Center in 1956 [2]. One of the first dwarfs treated in this way, who reached normal height, was in good health 62 years later [3]. However, the discovery of the human growth hormone (GH) took place a year earlier, 1955, by Choh Hao Li, who worked at the University of California, within his studies on the isolation of pituitary hormones.…”