Enhanced linear growth responses in hypopituitary dwarfs treated with growth hormone plus androgen versus growth hormone alone

Extract: Twelve hypopituitary patients ranging in age from 5 8/12 to 15 7/12 years were treated for 12 months with a standardized dose of human growth hormone (HGH), 0.1 or 0.05 U/kg three times weekly). From the 7th to 12th month inclusive, fluoxymesterone, 2.5 mg/m2/24 hr per os was given in combination with the growth hormone. From the 12th to the 18th month, no therapy was given. Heights and weights were recorded every 1 or 2 months. Bone age films were assessed at the onset and again in the 6th, 12th, and 18th month of the study. In the first 6 months of HGH therapy, the mean growth rate (centimeters per year ± SD) was 9.4 ± 2.3. During combined treatment with HGH and fluoxymesterone, the mean growth rate of 13.4 ± 3 was significantly greater (P < 0.001) than on HGH alone. Post-treatment mean growth rate from the 13th through 18th month, inclusive, was 2.7 ± 1.2. Weight gain (kilograms per year ± SD) during combined treatment (13 ± 7) was significantly greater (P < 0.001) than during HGH administration (3.4 ± 2.4). Mean advancement in bone maturation (months ± SD) during HGH (12 ± 7.7) was not significantly different from the mean gain in bone age during combined treatment (12 ± 12). In the final 6 months without any therapy, the mean gain in bone age was 8.8 ± 6.1. In the 18 months of study, the mean increase in bone age was 33 months, and the mean gain in height age (HA) was 23 months. Although final evaluation of this treatment program depends upon a longer period of observation, the immediate assessment suggests that the significant improvements in height, weight, and physical appearance were sufficient to compensate for the gains in bone maturation, especially since the patients who entered the study had markedly retarded bone ages. Speculation: HGH and androgens interact synergistically. Androgens stimulate HGH secretion in intact animals. In the hypopituitary state, androgens require the addition of HGH for optimal promotion of optimal growth and secondary sexual development.