Linear growth and final height after treatment for Cushing's disease in childhood

Gushing's disease is associated with growth failure in childhood and adoles cence. Growth and final height were analyzed in 10 patients who were cured or in remission after treatment of Gushing's disease. Seven males and 3 fem ales, aged 6.8-17.6 yr (bone age, 3.3-15.4 yr), had transsphenoidal surgery , which was combined with pituitary irradiation (4500 cGy in 25 fractions) in 5 patients. At presentation, 5 patients were prepubertal (males), and 5 were pubertal (2 males and 3 females). The mean height so score was -2.15 /- 1.26 (range, -0.21 to -4.32) compared with mean target height SD score o f -0.43 +/- 0.58. Height velocity in 6 patients was subnormal (0.9-3.8 cm/y r). After treatment, short-term height velocity, over a mean interval of 0. 57 yr, in 8 patients not receiving human GH (hGH) therapy, was variable (ra nge, 0.8-7.6 cm/yr). GH stimulation tests (insulin tolerance test/glucagon) in 9 subjects showed peak GH levels of 0.5-20.9 mU/L. Eight were treated w ith hGH (14 IU/m(2).wk), combined in 2 girls and 1 boy with a GnRH analog. After 1 yr of hGH, the mean height so score had increased from -2.45 +/- 1. 0 at initiation of hGH to -2.07 +/- 1.2 (P = 0.01). GH therapy was continue d until final height or latest assessment. The mean final height so score ( n = 6) was -1.24 +/- 1.38, and at the latest assessment the mean height so score (n = 4) was -1.52 +/- 1.33. Combining these 2 groups, the mean height so score was -1.36 +/-: 1.29. The difference between final or latest heigh t sn score and target height so score was 0.93 +/- 1.13, i.e. less (P = 0.0 05) than the difference between height and target height so score of 1.72 /- 1.26 at presentation. In conclusion, catch-up and favorable long-term gr owth was seen after treatment for Gushing's disease. Posttreatment GH defic iency was frequent, and early hGH replacement may have contributed to the e ncouraging outcome.