EARLY TREATMENT OF HYPOPITUITARISM

There are very few reports on the effect of treatment with human growt h hormone (hGH) of hypopituitarism in the first three years of life, a lthough early treatment is probably the main requirement for obtaining good end results. Therefore the effect of hGH therapy has been studie d retrospectively in six patients (three males) affected by hypopituit arism (multiple deficiency in five) diagnosed in the first two years o f life. At the onset of hGH therapy mean age was 16 months (range 5-24 ); the mean dose has been 0,55+/-0.19 (SD) I.U/Kg/week (range 0,3-0,7) , in three time/week in three subjects, by daily injections in three o f hem more recently treated. At the age of three years the mean treatm ent period has been 20 months (range 12-31). Linear growth velocity (G V), in the semester pre-therapy and every six months on therapy, has b een calculated in standard deviation score (SDS) for chronological age (CA) and for one age (BA); moreover for every six-months period mean values of T4 and T3 have been calculated. Four patients achieved a sha rp catch-up growth (CA-SDSGV > + 2 DS) both in the first and second si x-months; however the CA-SDSGV has been greater than 0,5 DS in the who le treatment period. T3 levels correlated with SDSGV for bone age (r=0 ,60; p <0.01). Mean length gain achieved on therapy at the age of thre e years has been greater than 2 DS for chronological age (from -3,84+/ -1,59 SDS to -1,07+/-1,47) and 0,5 for bone age (from -0,72+/-1,47 to -0,10+/-1.09). Bone age-chronological age ratio has increased from 0.4 2+/-0,23 at onset to 0, 79+/-0,18 at the age of three years. It is con cluded that hGH therapy initiated within two years of age is effective in achieving normalization of length at age of three years without im pairing bone age.