HYPOPITUITARISM AND PRECOCIOUS PUBERTY (PP)

Abstract

Three girls and one boy with hypopituitarism owing to histiocytosis (#2,3) and to cranial radiation for a craniopharyngioma (#1) and a thalamic tumor (#4) developed PP. Signs of sexual precocity were noted prior to treatment with somatotropin (HGH) in 3 patients, and during the course of therapy in one. Clinical and laboratory data are indicated below. While in patient #2 there was a normal growth velocity associated with puberty, in patient #3 the growth spurt was subnormal;in both patients menses started at 11-11½ yrs. Five yrs after the onset of PP the CA/HA/BA ratios in patients #2 and 3 were 12½/11½/14 and 13½/10½/15, respectively. In the other 2 patients, the CA/HA/BA ratios 1½ yrs after onset of PP were 8½/7½/7½ (#1) and 10/5½/10(#4). These findings indicate that 1) sexual precocity does occur in the presence of hypopituitarism, 2) there is a rapid skeletal maturation before clinical signs of PP are apparent, and 3) the pubertal growth spurt even if adequate does not result in a normal adult height if there is an abnormal HA/BA ratio at the onset of PP. We submit that in these patients for achievement of an average height PP must be curtailed by pharmacologic means until the HA/BA ratio is normalized by treatment with HGH.