Adult height in patients with permanent growth hormone deficiency with and without multiple pituitary hormone deficiencies.
BACKGROUND
It has been reported that patients with multiple pituitary hormone deficiencies (MPHDs) achieve a greater final height, compared with patients with isolated GH deficiency (IGHD). However, the outcome of patients with permanent GH deficiency (GHD) has not yet been reported.


OBJECTIVE
The objectives of the study were to evaluate and compare adult height data and the effect of spontaneous or induced puberty after long-term treatment with GH in young adults with either permanent IGHD or MPHD.


METHODS
This was a retrospective multicenter study conducted in university research hospitals and a tertiary referral endocrine unit.


METHODS
Thirty-nine patients with IGHD (26 males, 13 females) and 49 with MPHD (31 males, 18 females), diagnosed at a median age of 7.7 and 6.9 yr, respectively, were reevaluated for GH secretion after adult height achievement (median age 17.6 and 19.8 yr). The diagnosis of permanent GHD was based on peak GH levels less than 3 microg/liter after an insulin tolerance test or peak GH levels less than 5 microg/liter after two different tests. Fifteen subjects had idiopathic GHD and seventy-three had magnetic resonance imaging evidence of congenital hypothalamic-pituitary abnormalities. Height sd score (SDS) was analyzed at diagnosis, the onset of puberty (either spontaneous or induced), and the time of GH withdrawal.


RESULTS
The subjects with IGHD entered puberty at a median age of 12.6 yr (females) and 13.4 yr (males). Puberty was induced at a median age of 13.5 and 14.0 yr, respectively, in males and females with MPHD. Median height SDS at the beginning of puberty was similar in the IGHD and MPHD subjects. Total pubertal height gain was similar between patients with IGHD or MPHD. Median adult height was also not significantly different between IGHD and MPHD patients (males, 168.5 vs. 170.3 cm; females, 160.0 vs. 157.3 cm). The adult height SDS of the IGHD subjects was positively correlated with height at the time of diagnosis and with total pubertal height gain. Conversely, the adult height SDS of the MPHD subjects was positively correlated with both the duration of GH treatment and height SDS at the time of GHD diagnosis.


CONCLUSIONS
Adult height in patients with permanent IGHD and spontaneous puberty is similar to adult height in patients with MPHD and induced puberty.
Maghnie
Mohamad
M
Department of Pediatrics, Instituto di Ricovero e Cura a Carattere Scientifico Giannina Gaslini, University of Genoa, Largo Gerolamo Gaslini 5, 16147 Genoa, Italy. mohamadmaghnie@ospedale-gaslini.ge.it
Ambrosini
Linda
L
Cappa
Marco
M
Pozzobon
Gabriella
G
Ghizzoni
Lucia
L
Ubertini
Maria Grazia
MG
di Iorgi
Natascia
N
Tinelli
Carmine
C
Pilia
Sabrina
S
Chiumello
Giuseppe
G
Lorini
Renata
R
Loche
Sandro
S