Results of Four Years of Intermittent Human Growth Hormone (hGH) and Fluoxymesterone Therapy in Hypopituitary Dwarfism

Abstract

In order to investigate the synergistic effect on growth of human growth hormone (hGH) and an anabolic agent, fluoxymesterone, 28 children with hypopituitarism received the combined therapy in an intermittent regimen for one to four years. Fourteen of the children had received prior therapy with growth hormone alone. All of the children were prepubertal. They had a mean chronologic age (CA) of 9.53 years ± 2.33 SD and mean bone age (BA) of 6.05 years ± 2.07 SD. The change in BA/change in height age (HA) ≤1 in 15 of the 28 children (53.6%). The change in HA/change in CA was ≥1 in 17 of 28 (60.7%). The 14 children who had received hGH therapy alone, group A, had a growth velocity of 4.72 cm/yr ± 1.24 SD in the year prior to the combined treatment. This did not differ significantly from the average growth velocity of 5.58 cm ± 1.47 SD during the first year of combined therapy. The average growth velocity of the remaining 14 children, group B, during the first year of combined therapy was 6.72 cm/yr ± 1.01 SD. This differed significantly from the growth velocity of group A before combined therapy (P < .001) and also during the first year of combined therapy (P < .025). The overall mean growth rate in the second year, 5.33 cm, was less than that of the first year, P < .025, and was not different from that achieved with hGH alone. Furthermore, the velocity in each of the following years was similar to that of the second year. The use of intermittent combined therapy in the doses employed in this study does not appear to be of benefit in prolonging catch-up growth in hypopituitary patients. This regimen provides acceleration of growth in the initial year of therapy for those children who have not received prior hGH therapy.