Delayed growth and adolescence (D.G.A.) with lack of adrenarche: catch-up of growth with dehydroepiandrosterone sulfate (DHAS) therapy

Abstract

We have good evidence that there are 2 main types of DGA : in type I growth and tone age (BA) velocities usually slow down between 6/8 years (y), sometimes earlier, in children who often have short stature; in type II the decrease of growth and BA starts between 12/13 y in girls and 13/14 y in boys. A lack of adrenarche as indicated by low plasma levels of dehydroepiandrosterone (DHA) is present in typeI; normal adrenarche is present in type II as in hypogonadotrophic hypogonadism. To test the hypothesis that the lack of adrenarche is responsible for the DGA in type I we studied the effect of DHAS therapy in a 12 y old girl with typical type I. Except for consistently low plasma levels of DHA : 10 to 22 ng/dl, all endocrine functions were normal. DHAS was given as a single oral morning dose of 5 mg/day for one y : growth velocity increased from 3.5 to 9 cm/y with a growth over BA velocities ratio = 1.3. From this preliminary study we suggest that a lack of adrenarche is responsible for the delayed maturation in DGA type I and that oral DHAS could be a useful substitutive therapy.