TRATTAMENTO PRECOCE DELL'IPOPITUITARISMO

There are very few reports on the effect of treatment with human growth hormone (hGH) of hypopituitarism in the first three years of life, although early treatment is probably the main requirement for obtaining good end results. Therefore the effect of hGH therapy has been studied retrospectively in six patients (three males) affected by hypopituitarism (multiple deficiency in five) diagnosed in the first two years of life. At the onset of hGH therapy mean age was 16 months (range 5-24); the mean dose has been 0,55 ± 0,19 (SD) I.U./Kg/week (range 0,3-0,7), in three times/week in three subjects, by daily injections in three of them more recently treated. At the age of three years the mean treatment period has been 20 month (rang 12-31). Linear growth velocity (GV), in the semester pre-therapy and every six months on therapy, has been calculated in standard deviation score (SDS) for chronological age (CA) and for bone age (BA); moreover for every six-months period mean values of T4 and T3 have been calculated. Four patients achieved a sharp catch-up growth (CA-SDSGV > + 2 DS) both in the first and second six-months; however the CA-SDSGV has been greater than 0,5 DS in the whole treatment period. T3 levels correlated with SDSGV for bone age (r = 0,60; p < 0,01). Mean length gain achieved on therapy at the age of three years has been greater than 2 DS for chronological age (from -3,84 ± 1,59 SDS to -1,07 ± 1,47) and 0,5 for bone age (from -0,72 ± 1,47 to -0,10 ± 1.09). Bone age-chronological age ratio has increased from 0,42 ± 0,23 at onset to 0,79 ± 0,18 at the age of three years. It is concluded that hGH therapy initiated within two years of age is effective in achieving normalization of length at age of three years without impairing bone age.