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August 1988, Vol 142, No. 8 >
Article | August 1988

When Should Hydrocortisone Therapy Be Instituted in Children With Hypopituitarism? FREE

Lima Witz, MD; Zeev Josefsberg, MD; Haiuta Kaufman, PhD; Zvi Laron, MD
[+] Author Affiliations

Accepted for publication March 28, 1988.

Reprint requests to Beilinson Medical Center, Petah Tikva 49 100, Israel (Dr Laron).


Am J Dis Child. 1988;142(8):881-883. doi:10.1001/archpedi.1988.02150080087030.
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• The records of 72 pediatric and adolescent patients with multiple hypothalamic and/or pituitary hormone deficiencies of nontumoral origin who were followed up for years and receiving somatropin, thyroxine, and sex hormones at the appropriate age have been reviewed. According to their corticotropin-releasing factor–corticotropin–cortisol (CAC) axis function as evaluated by basal plasma cortisol levels and the response of cortisol to insulin hypoglycemia and to corticotropin-releasing factor, the patients were divided into three groups: group 1 (n=25), patients with multiple hypothalamic and/or pituitary hormone deficiencies with normal CAC axis; group 2 (n =38), patients with partial CAC deficiency without cortisol replacement therapy (hydrocortisone); and group 3 (n=9), patients with CAC deficiency receiving hydrocortisone therapy (5 to 10 mg/d). Repeated CAC axis evaluation in patients of group 2 over years revealed a progressive decrease in the basal and stimulated cortisol levels with age and pubertal advancement. Despite the low cortisol levels and the low cortisol response to insulin hypoglycemia, these patients did not have clinical symptoms until the end of puberty when nine of 24 patients complained of abdominal pain, weakness, or anorexia. Linear growth, which was followed up in all patients at regular intervals, showed a lower growth velocity and irregular growth in response to somatropin treatment in the patients receiving low doses of hydrocortisone (group 3 patients when compared with group 2 patients not receiving hydrocortisone).

(AJDC 1988;142:881-883)

REFERENCES

1 +
Laron Z:  The hypothalamus and the pituitary gland (hypophysis) , in Hubble DW (ed): Pediatric Endocrinology . Boston, Blackwell Scientific Publications Inc, 1969;, pp 35-111.
2 +
Laron Z:  Disorders of the pituitary gland , in Gellis SS, Kagan BM (eds): Current Pediatric Therapy , ed 4. Philadelphia, WB Saunders Co, 1970;, pp 450-456.
3 +
Job JC:  The pituitary , in Job JC, Pierson M (eds): Pediatric Endocrinology . New York, John Wiley & Sons Inc, 1981;, pp 85-160.
4 +
Kaplan SA:  Growth and growth hormone: Disorders of the anterior pituitary , in Kaplan SA (ed): Clinical Pediatric and Adolescent Endocrinology . Philadelphia, WB Saunders Co, 1982;, pp 1-48.
5 +
Galatzer A, Nofar E, Beit-Halachmi N, et al:  Intellectual and psychological functions in children, adolescents and young adults before and after operation of craniopharyngioma . Child Care Health Dev 1981;;7:307-316.
6 +
Tanner JM, Whitehouse RH, Takaishi M:  Standards from birth to maturity for height, weight, height velocity and weight velocity: I. British children 1965 . Arch Dis Child 1966;;41:454-471.
7 +
Tanner JM, Whitehouse RH, Takaishi M:  Standards from birth to maturity for height, weight, height velocity and weight velocity: II. British children 1965 . Arch Dis Child 1966;;41:613-635.
8 +
Bauman B, Pertzelan A, Josefsberg Z, et al:  Effect of CRF-1-41 as compared to insulin hypoglycemia (ITT) on plasma cortisol and ACTH in subjects with intact or defective hypothalamic pituitary functions , abstracted. Pediatr Res 1985;;19:618.
9 +
Laron Z, Karp M, Nitzan M, et al:  The plasma 11-hydroxycorticosteroids response to insulin-induced hypoglycemia in children and adolescents . Acta Endocrinol 1969;;69:451-462.
10 +
Petersen KE:  ACTH in normal children and children with pituitary and adrenal diseases. II. Plasma ACTH (cortisol and growth hormone) values during insulin hypoglycaemia—patients with idiopathic hypopituitarism and intracranial tumour . Acta Paediatr Scand 1984;;73:372-378.
11 +
Toppet M, Wolter R, Smets P, et al:  Variations in the plasma cortisol response to insulin hypoglycemia in children . Acta Paediatr Belg 1972;;26:225-240.
12 +
Harsoulis P, Marshall JC, Kuku SF, et al:  Combined test for assessment of anterior pituitary function . Br Med J 1973;;4:326-329.
13 +
Eskildsen PC, Jacobsen BB, Kastrup KW, et al:  Combined test of hypothalamic-pituitary function in growth-retarded children treated with growth hormone: II. Secretion of LH, FSH, TSH, prolactin and ACTH . Acta Paediatr Scand 1979;;277( (suppl) ):14-20.
14 +
Laron Z, Butenandt O, Raiti S (eds): Clinical Use of Growth Hormone—Present and Future Aspects: Pediatric and Adolescent Endocrinology . New York, S Karger AG, 1987;, vol 16, pp 1-270.
15 +
Zachmann M:  Synergistic effects between hGH and sex hormones , in Laron Z, Butenandt O, Raiti S (eds): Clinical Use of Growth Hormone—Present and Future Aspects: Pediatric and Adolescent Endocrinology . New York, S Karger AG, 1987;, vol 16, pp 72-87.
16 +
Galatzer A, Aran O, Beit-Halachmi N, et al:  Rehabilitation status of young adults with hGH deficiency after termination of therapy , in Laron Z, Butenandt O, Raiti S (eds): Clinical Use of Growth Hormone—Present and Future Aspects: Pediatric and Adolescent Endocrinology . New York, S Karger AG, 1987;, vol 16, pp 257-267.

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References

1 +
Laron Z:  The hypothalamus and the pituitary gland (hypophysis) , in Hubble DW (ed): Pediatric Endocrinology . Boston, Blackwell Scientific Publications Inc, 1969;, pp 35-111.
2 +
Laron Z:  Disorders of the pituitary gland , in Gellis SS, Kagan BM (eds): Current Pediatric Therapy , ed 4. Philadelphia, WB Saunders Co, 1970;, pp 450-456.
3 +
Job JC:  The pituitary , in Job JC, Pierson M (eds): Pediatric Endocrinology . New York, John Wiley & Sons Inc, 1981;, pp 85-160.
4 +
Kaplan SA:  Growth and growth hormone: Disorders of the anterior pituitary , in Kaplan SA (ed): Clinical Pediatric and Adolescent Endocrinology . Philadelphia, WB Saunders Co, 1982;, pp 1-48.
5 +
Galatzer A, Nofar E, Beit-Halachmi N, et al:  Intellectual and psychological functions in children, adolescents and young adults before and after operation of craniopharyngioma . Child Care Health Dev 1981;;7:307-316.
6 +
Tanner JM, Whitehouse RH, Takaishi M:  Standards from birth to maturity for height, weight, height velocity and weight velocity: I. British children 1965 . Arch Dis Child 1966;;41:454-471.
7 +
Tanner JM, Whitehouse RH, Takaishi M:  Standards from birth to maturity for height, weight, height velocity and weight velocity: II. British children 1965 . Arch Dis Child 1966;;41:613-635.
8 +
Bauman B, Pertzelan A, Josefsberg Z, et al:  Effect of CRF-1-41 as compared to insulin hypoglycemia (ITT) on plasma cortisol and ACTH in subjects with intact or defective hypothalamic pituitary functions , abstracted. Pediatr Res 1985;;19:618.
9 +
Laron Z, Karp M, Nitzan M, et al:  The plasma 11-hydroxycorticosteroids response to insulin-induced hypoglycemia in children and adolescents . Acta Endocrinol 1969;;69:451-462.
10 +
Petersen KE:  ACTH in normal children and children with pituitary and adrenal diseases. II. Plasma ACTH (cortisol and growth hormone) values during insulin hypoglycaemia—patients with idiopathic hypopituitarism and intracranial tumour . Acta Paediatr Scand 1984;;73:372-378.
11 +
Toppet M, Wolter R, Smets P, et al:  Variations in the plasma cortisol response to insulin hypoglycemia in children . Acta Paediatr Belg 1972;;26:225-240.
12 +
Harsoulis P, Marshall JC, Kuku SF, et al:  Combined test for assessment of anterior pituitary function . Br Med J 1973;;4:326-329.
13 +
Eskildsen PC, Jacobsen BB, Kastrup KW, et al:  Combined test of hypothalamic-pituitary function in growth-retarded children treated with growth hormone: II. Secretion of LH, FSH, TSH, prolactin and ACTH . Acta Paediatr Scand 1979;;277( (suppl) ):14-20.
14 +
Laron Z, Butenandt O, Raiti S (eds): Clinical Use of Growth Hormone—Present and Future Aspects: Pediatric and Adolescent Endocrinology . New York, S Karger AG, 1987;, vol 16, pp 1-270.
15 +
Zachmann M:  Synergistic effects between hGH and sex hormones , in Laron Z, Butenandt O, Raiti S (eds): Clinical Use of Growth Hormone—Present and Future Aspects: Pediatric and Adolescent Endocrinology . New York, S Karger AG, 1987;, vol 16, pp 72-87.
16 +
Galatzer A, Aran O, Beit-Halachmi N, et al:  Rehabilitation status of young adults with hGH deficiency after termination of therapy , in Laron Z, Butenandt O, Raiti S (eds): Clinical Use of Growth Hormone—Present and Future Aspects: Pediatric and Adolescent Endocrinology . New York, S Karger AG, 1987;, vol 16, pp 257-267.

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