Growth without growth hormone: growth pattern and final height of five patients with idiopathic combined pituitary hormone deficiency.
BACKGROUND
Growth without GH has been reported in patients with organic combined pituitary hormone deficiency (CPHD) after resection of craniopharyngiomas and hypothalamic tumours or in septo-optic dysplasia.


METHODS
This study describes the growth pattern and final height of five children (four boys, one girl) with idiopathic CPHD (GH, TSH, ACTH, LH and FSH) who maintained normal growth despite persistent GH deficiency throughout the growth period.


RESULTS
Presenting findings were borderline small penis in two children diagnosed at ages 3 and 9 years, and absence of pubertal signs in three adolescents diagnosed at age 12.8-13.7 years. The latter three patients also exhibited acromegaloid features. The height of all patients was within the 10-25th percentiles, and weight at the 25-50th percentiles. Although they were moderately overweight, accelerated weight gain was not observed. Prepubertal growth rate was 4-5 cm/year. The pubertal growth period, starting after initiation of sex hormone therapy (chronological age 15.9-16.3 years and bone age 12.5-14.5 years) continued for 4-5.5 years. Total pubertal growth was 6-11.7 cm with reduced growth spurt. Final height, which was attained at an advanced age (19-22 years), was 170-179 cm in the boys and 164 cm in the girl, equal to or exceeding the target height range. Repeated hormonal evaluations revealed undetectable GH and IGF-I levels, and no evidence of hyperprolactinaemia or hyperinsulinism.


CONCLUSIONS
Final height attainment within or above target height range may occur in patients with idiopathic CPHD despite persistent GHD. As this was not mediated by GH, IGF-I, insulin or prolactin, some other growth factors probably played a growth-promoting role.
Lazar
Liora
L
Institute for Endocrinology and Diabetes, Schneider Children's Medical Center of Israel, Petah Tikva and Faculty of Medicine, Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
Dan
Sivan
S
Phillip
Moshe
M
D000293:Adolescent; D001827:Body Height; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D012739:Gonadal Steroid Hormones / Q000008:administration & dosage; D006128:Growth; D013006:Growth Hormone / Q000097:blood / Q000172:deficiency*; D006801:Humans; D007018:Hypopituitarism / Q000097:blood / Q000188:drug therapy / Q000503:physiopathology*; D007328:Insulin / Q000097:blood; D007334:Insulin-Like Growth Factor I / Q000032:analysis / Q000172:deficiency; D008297:Male; D010907:Pituitary Hormones / Q000008:administration & dosage / Q000172:deficiency*; D011388:Prolactin / Q000097:blood
D012739:Gonadal Steroid Hormones; D007328:Insulin; D010907:Pituitary Hormones; D007334:Insulin-Like Growth Factor I; D011388:Prolactin; D013006:Growth Hormone