Pubertal Growth and Final Height in Hypopituitary Boys: A Minor Role of Bone Age at Onset of Puberty*

Abstract

Twenty-two hypopituitary boys treated with human GH were studied longitudinally before and during puberty. Eight patients entered spontaneous puberty at a mean bone age of 12.4 +/- 1.0 (+/- SD) yr. Height velocity reached a mean peak of 6.8 cm/yr during the second year of spontaneous puberty. In these patients, the mean total height gain throughout puberty was 22.8 +/- 5.2 cm, and the mean final height was 158.6 +/- 7.2 cm. Fourteen patients received testosterone enanthate (100 mg/month, im) starting at a mean bone age of 13.6 +/- 1.1 yr. Height velocity was maximal (7.5 cm/yr) during the first year of therapy. The mean final height was 162.9 +/- 5.0 cm, with a mean pubertal gain of 15.9 +/- 3.8 cm. Genital development, peak height velocity, and increase in plasma testosterone levels occurred earlier during testosterone therapy than during spontaneous puberty. In both groups of patients, there was a positive correlation between the bone age at onset of puberty and the height at onset of puberty (r = 0.65). There was also a negative correlation between bone age and total pubertal height gain (r = -0.73). This reduction in pubertal height increase was less than expected for bone age at onset of puberty, which can be explained by a decrease in bone age velocity in relation to bone age at onset of puberty (r = -0.81). Therefore, advancement in bone age at the onset of testosterone therapy did not impair final height, whereas it may increase height at onset of puberty, which is the major factor in final height. We conclude that in GH- and gonadotropin-deficient boys 1) a reduced dosage of testosterone enanthate (25 mg twice a month, im) should be used to induce pubertal development, and 2) the major criterion to decide when to give testosterone is height reached at that time regardless of bone age.

Evaluation of Prepubertal Patients with Suspected Neurosecretory Dysfunction of Growth Hormone Secretion: Diagnostic Steps and Treatment Response

“…Regarding the whole group, auxological data after the first year of therapy showed a good response (ΔH-SDS > 0,5 in 69%). Our results for the increases of H-SDS, HV, and HV-SDS as well as HV during the first year are comparable with or even higher than shown by many other studies for GH treatment in children with GHD [1,18,[22][23][24]. A good response to GH-therapy in NSD-patients has already been reported 30 years ago [3] and was confirmed recently [25].…”

Basal Testosterone Secretion and Response to Human Luteinizing, Follicle-Stimulating, and Growth Hormones in Culture of Cells Isolated from Testes of Infants and Children

“…The effect of GH that we have found in our studies suggests that either GH or PRL might have a physiologic role in testicular function of infants during the first semester of life. It is known that patients with GH deficiency (35) or GH insensitivity (36) have a remarkable delay in their sexual development. Whether this could be attributed to lack of GH action in the testes at early infancy remains to be shown.…”

Final height of patients treated for isolated GH deficiency: examination of 83 patients

“…All this would suggest, on the one hand, postponing the onset of puberty, in particular when height is clearly unsatisfactory and, on the other, starting the treatment as soon as possible in order to reduce the deficiency in stature. It is not clear, however, whether manipulation of the onset of puberty obtained with the use of luteinizing hormone-releasing hormone analogues is able to improve final height (32)(33)(34)(35) and here again we are faced with diagnostic uncertainties (21). Since about 85-90% of final height in the normal subject is obtained before puberty, it would seem that the chances of improving final height during puberty are minimal.…”