22 GROWTH IMPAIRMENT ASSOCIATED WITH HYPERCORTISOLISM: RESPONSE TO GROWTH HORMONE THERAPY

Abstract

Hypercortisolism decreases responsiveness to GH, leading to impairment of growth. The 24-h integrated concentration of cortisol (IC-F) proved to be an accurate diagnostic procedure for hypercortisolism. In children aged 7-18 yr (n=26) of normal stature, the IC-F, mean ±1SD, was 5.9±1.6 μg/dl. In Cushing's disease, the IC-F was 20.2±4.7 μg/dl (n=13)(JCEM 54:1072, 1982).We have identified 5 children (ages 10-14 yr) who presented with short stature (less than 5% for age), slow growth (less than 4.5 cm/yr) and bone age delay (greater than 2 SD for age). All were euthyroid and their stimulated GH and 24-h IC-GH were normal. None of the patients were obese, had striae, or other classical physical findings of Cushing's syndrome. However, their IC-F ranged from 13.2-17.2 μg/dl, clearly in the range of patients with Cushing's syndrome. Two of the children were treated for 8 months with GH (0.2 U/kg three times per week) and had increased growth rate of 10.6 and 8 cm/yr respectively. A third child who was treated with less GH (0.1 U/kg three times per week) increased her growth rate from 4.5 to 5.7 cm/yr.Conclusion: 1/Poor growth associated with hypercortisolism may occur in children who do not look Cushingoid. 2/Such children are responsive to GH therapy.