Dehydroepiandrosterone (DHEA) replacement reduces growth hormone (GH) dose requirement in female hypopituitary patients on GH replacement.
OBJECTIVE
GH dose requirement is lower in ACTH replete compared with ACTH deficient hypopituitary patients suggesting that adrenal androgens may augment IGF-I generation for a given GH dose. This study aimed to determine the effect of dehydroepiandrosterone (DHEA) administration on GH dose requirements in hypopituitary adults.


METHODS
A double blind placebo controlled trial was conducted adding 50 mg DHEA to the standard replacement of hypopituitary patients, including GH, over an initial 6 months, followed by an open phase study of 6 months DHEA replacement and a final 2 month washout phase after DHEA withdrawal. The dose of GH was adjusted to achieve a constant serum IGF-I.


METHODS
Thirty female and 21 male hypopituitary patients were enrolled. Data from 26 women and 18 men were analysed after patient withdrawal.


METHODS
The primary outcome objective was the GH dose required to achieve a stable serum IGF-I. Secondary outcome measures were lipoprotein profiles, insulin, insulin sensitivity, IGFBP-3, waist/hip ratio and indices of bone remodelling.


RESULTS
DHEA replacement in female patients lead to a 14.6 +/- 20% reduction in the dose of GH for a constant serum IGF-I (P < 0.05, 95% CI: 1.8, 32.7). This was maintained for 12 months and there was a significant fall in serum IGF-I two months after withdrawal of DHEA. There was no change in the male group.


CONCLUSIONS
DHEA replacement may reduce GH dose requirements in female hypopituitary patients.
Brooke
Antonia M
AM
Centre for Clinical Endocrinology, William Harvey Research Institute, St.Bartholomew's Hospital, QMUL, London, UK.
Kalingag
Leonila A
LA
Miraki-Moud
Farideh
F
Camacho-Hübner
Cecilia
C
Maher
Katharine T
KT
Walker
Dorothy M
DM
Hinson
Joy P
JP
Monson
John P
JP
D000328:Adult; D016009:Chi-Square Distribution; D002784:Cholesterol / Q000097:blood; D008076:Cholesterol, HDL / Q000097:blood; D003687:Dehydroepiandrosterone / Q000097:blood / Q000627:therapeutic use*; D004311:Double-Blind Method; D004334:Drug Administration Schedule; D005260:Female; D013006:Growth Hormone / Q000097:blood; D020249:Hormone Replacement Therapy; D019382:Human Growth Hormone / Q000008:administration & dosage* / Q000627:therapeutic use; D006801:Humans; D007018:Hypopituitarism / Q000097:blood / Q000188:drug therapy*; D018972:Insulin-Like Growth Factor Binding Protein 3 / Q000097:blood; D007334:Insulin-Like Growth Factor I / Q000032:analysis; D008297:Male; D013997:Time Factors; D014280:Triglycerides / Q000097:blood
D008076:Cholesterol, HDL; D018972:Insulin-Like Growth Factor Binding Protein 3; D014280:Triglycerides; D019382:Human Growth Hormone; D003687:Dehydroepiandrosterone; D007334:Insulin-Like Growth Factor I; D013006:Growth Hormone; D002784:Cholesterol