[Long-term fate of pituitary dwarfs treated with growth hormone]. / Le devenir à long terme des nains hypophysaires traités par l'hormone de croissance.

A questionnaire having been mailed to 50 hypopituitary patients aged 18 to 36 years (m 21.7 +/- 3.4) previously treated with human growth hormone for at least 3 years, 44 answers have been received. The final height is 2.1 +/- 0.9 standard deviations below the average. However 57% of the patients consider it is sufficient. The smallness is felt as a handicap by 20% only of these adults, though 88% had suffered for it during their adolescence. The treatment is retrospectively considered as useful and acceptable by 68%, heavy but useful by 25%, heavy and useless by 7%, without correlation with the results. Only 41% are satisfied with their school achievements. However, more than two thirds of patients had severe school difficulties at the time of onset of the treatment. Actually 75% of the patients are professionally qualified, among whom 36% have achieved high school, and most have an educational level similar to that of their parents or even higher. But 41% only have an employment, 27% are still students and 32% are unemployed. The way of life of the young hypopituitary adults is severely affected: 6 only are married or living with a mate, 11 only write they have occasional sexual experiences, 16 remain completely alone. In contrast, leisure activities are good in more than 90%. A score taking all these data into consideration to evaluate their way of life shows, among the 43 complete answers to the questionnaire, 16% with excellent results, 49% with a rather good social status and 35% with poor final result.(ABSTRACT TRUNCATED AT 250 WORDS)

[Effects of gonadoliberin administered nasally in cryptorchidism in aged 1 to 6]. / Effets de la gonadolibérine (LHRH) par voie nasale chez les enfants cryptorchides de 1 à 6 ans.

93 cryptorchid boys aged 1 to 6 years were treated with nasal spray of LHRH according with two different protocols: 0.4 mg thrice daily during 28 consecutive days in 39 (32 uni and 7 bilaterally cryptorchid) and 0.4 mg twice daily on alternate days three days per week for 1 month in 32 and 3 months in 22 (34 uni and 20 bilaterally cryptorchid). The results did not vary according to age or to the protocol and duration of treatment. Complete testicular descent was obtained for only 10% of unilaterally undescended testes, and reached 29% in bilaterally undescended testes. These results do not relate to the more or less high position of the testis nor to hypothetical changes in plasma gonadotropins or testosterone. The treatment had very minor side-effects. For this reason, in spite of its very limited results, it may be used either as an attempt before surgery at 4-6 years or as a means to distinguish retractile from undescended testes.

The pituitary-gonadal axis in cryptorchid infants and children.

We have attempted to document in cryptorchid children that there is an LH deficiency and a secondary deficiency of testosterone. We have shown a diminished LH peak after LH-RH in cryptorchid versus normal infants (P less than 0.05). The postnatal surge of testosterone is significantly low (P less than 0.001) in permanent cryptorchids versus infants with secondary testicular descent, whose levels are similar to those in controls. In permanent cryptorchids during the same period (0-4 months), LH and testosterone levels were significantly lower (P less than 0.01 and P less than 0.05 respectively) than in infants with secondary descent, and the levels of testosterone and LH were correlated in both populations. In children, a low basal level of LH was observed at pubertal stage P2, and LH peak after LH-RH was significantly reduced at stages P1 and P2 (P less than 0.01 and P less than 0.05 respectively). The post-stimulatory levels of testosterone after hCG were reduced at the same stages (P less than 0.01, P less than 0,05), and the two levels were correlated (P less than 0.01). No differences are seen for LH and testosterone afterwards. It has been possible to show by immunofluorescence on pituitary cells the occurrence of antigonadotropin cell antibodies (AGCA) in more than 50% of our patients, with no relation to age and no correlations between endocrinological data and the presence or absence of AGCA. The relatively low success rate of hCG treatment, mainly in young children, and of GnRH irrespective of the regimen of treatment, does not exclude the role of primary LH deficiency in cryptorchidism.

Treatment of precocious puberty with a long-acting preparation of D-Trp6-LHRH.

D-Trp6-LHRH was tested in 6 girls 1-8 years old and 7 boys 2-10 years old with precocious puberty. All children had advanced bone age, breast or testis enlargement and a pubertal LH response to LHRH. 60 micrograms LHRH-A/kg body weight was given intramuscularly on days 1 and 21 and thereafter every 4 weeks for 6-21 months. In girls, breast enlargement disappeared and mean uterus size decreased within 6 months. Mean ovary length decreased from 25.0 +/- 1.9 to 16.0 +/- 2.7 (p less than 0.02). In boys, mean testis volume decreased from 8.0 +/- 1.1 to 6.7 +/- 1.4 ml (p less than 0.05) within 6 months. In both sexes, growth velocity decreased significantly and bone maturation was reduced. Plasma levels of estradiol or testosterone and FSH levels decreased significantly within 3 weeks. The LH response to LHRH was reduced to normal prepubertal values after 7 weeks. No secondary clinical or biochemical escape occurred. No side effects occurred except for transient vaginal bleeding in one girl after the first and second injection. No antibodies to LHRH-A were detected in the patients' sera. This study demonstrates the ability of a delayed release formulation of D-Trp6-LHRH to suppress pituitary and gonadal secretion and pituitary response to LHRH for as long as 2 years of therapy. This treatment appears to be more efficient in treating both clinical and biochemical abnormalities than does treatment with inhibitory steroids. Additionally the method of administration is more practical and ensures better patient compliance.

[Middle-term course of craniopharyngiomas in children as a function of initial therapeutic choice]. / Evolution à moyen terme des craniopharyngiomes de l'enfant en fonction des choix thérapeutiques initiaux.

Despite numerous studies and publications, the treatment of craniopharyngiomas in children remains controversial. The present series of 33 cases, followed for the last 10 years, is analysed according to therapeutic protocols jointly defined, case by case, from each patient's features and in restricting the extent of surgical excisions. In agreement with other recently published series, two options give superior results: complete excision, when the risk is low; in the other cases, partial excision or rather a simple biopsy or decompression, followed by irradiation. Risks of relapse are thus quite reduced and mortality greatly reduced. The unavoidable consequence of hypopituitarism is easily treated. However, the frequency of psychic and/or neurologic sequellae as well as the risk of post-radiation complications should not be disregarded when selecting treatment.

Long term treatment of male and female precocious puberty by periodic administration of a long-acting preparation of D-Trp6-luteinizing hormone-releasing hormone microcapsules.

The efficacy and safety of a delayed release formulation of the LHRH agonist D-Trp6-LHRH (LHRH-A; im microcapsules) were tested in 16 girls, 0.9-8.8 yr old, and 10 boys, 2.0-10.5 yr old, with precocious puberty. All children had advanced bone age, breast or testis enlargement, and a pubertal LH response to LHRH. Precocious puberty was idiopathic in 19 subjects and secondary to a brain tumor or other central nervous system abnormality in 7. Nine girls and 6 boys had been previously treated unsuccessfully with medroxyprogesterone and/or cyproterone acetate. The microcapsules were made of 2% LHRH-A dispersed in a biocompatible biodegradable polymeric matrix of DL-lactide-coglycolide. Sixty micrograms of LHRH-A/kg BW were given im on days 1 and 21 and thereafter every 4 weeks for 10-27 months. Plasma LHRH-A levels were measured in 13 children by means of a specific RIA. On days 3, 7, 14, and 21, mean concentrations (+/- SEM) were 295 +/- 44, 218 +/- 31, 215 +/- 45, and 224 +/- 39 pg/ml, respectively. In girls, breast enlargement disappeared, and mean uterus size decreased from 44.4 +/- 2.5 to 38.1 +/- 3.1 mm (mean +/- SEM; P less than 0.02) within 6 months. Mean ovary length decreased from 23.0 +/- 1.5 to 16.2 +/- 1.5 mm (P less than 0.01). In boys, mean testis volume decreased from 8.1 +/- 1.2 to 6.7 +/- 1.2 ml (P less than 0.02) within 6 months. In both sexes, growth velocity decreased significantly, and bone maturation was generally reduced. Plasma levels of estradiol or testosterone and FSH levels decreased significantly within 3 weeks. The LH response to LHRH was reduced to normal prepubertal values after 7 weeks. No secondary clinical or biochemical escape occurred. In 1 boy, all biological features of puberty recurred within 1 month after omission of the fifth injection. No side-effects occurred, except for transient vaginal bleeding in girls after the first or second injection. No antibodies to LHRH-A were detected in the patients' sera. This study demonstrates the ability of a delayed release formulation of LHRH-A to achieve stable levels of the drug in plasma for at least 21 days after a single im injection and to suppress pituitary and gonadal secretion and pituitary response to LHRH for as long as 2 yr after therapy. This treatment appears to be more efficient in treating both clinical and biochemical abnormalities than does treatment with inhibitory steroids. Additionally, the method of administration is more practical and ensures better patient compliance.

[Normal male phenotype or hypospadias and female karyotype. XX male syndrome in children and adolescents]. / Phénotype masculin normal ou hypospade et caryotype féminin. Le syndrome des mâles XX chez l'enfant et l'adolescent.

A morphologically normal 46 XX karyotype has been found in 8 patients with male phenotype, either normal (3 cases) or hypospadiac (5 cases) studied at age 1 month to 15 years. Five had cryptorchidism. Pubertal follow-up was obtained in 6 patients and showed that they had hypogonadism with small testes, and a mean adult height of 163 cm. The hormonal investigations gave normal results before puberty, then after the onset of puberty a hypergonadotropic hypogonadism. Testicular biopsy showed alterations from age 8 years. Studies using Y-specific probes in 3 patients have shown the presence of Y genetic material in 2 and absence in 1, thus demonstrating genetic heterogeneity of the XX males.

[Treatment of virilizing adrenal hyperplasia in adolescents. Use and side-effects of dexamethasone]. / Traitement de l'hyperplasie surrénale virilisante chez les adolescents. Emploi et inconvénients de la dexaméthasone.

Dexamethasone (DXM) has been used to reduce clinical and/or biological hyperandrogenism in 18 adolescent patients treated by hydrocortisone and fludrocortisone for congenital virilizing adrenal hyperplasia (CAH). The doses and duration of treatment did vary among these patients. Androgen excess has been suppressed in all cases, even treated with low doses. Side-effects have been noticed in 9 patients, 5 having large purple striae, and 4 having mild and transient hypercortisolism. The analysis of data shows that DXM may be used for the treatment of CAH in pubertal patients provided that its use remains limited to cases in which the usual treatment does not allow to avoid the androgen excess. In such patients, the dose of DXM at the onset of treatment should be 0.25 mg given once a day, at night, and should not exceed 0.5 mg daily; it has to be adjusted according to clinical results, avoiding to obtain subnormal androgen levels. Hydrocortisone and/or fludrocortisone have to be prescribed for short periods in situations of stress, but not as permanent association. Within these limits, DXM may be considered as a valuable means to obtain hormonal adjustment in CAH adolescent patients.

[Responses of somatotropin to stimuli after brief administration of estradiol in short children]. / Réponses de la somatotropine (GH) aux stimuli après administration brève d'estradiol chez les enfants de petite taille.

Ethinyl estradiol has been administered orally, 100 micrograms per day during three days, to enhance the growth hormone (GH) response to usual pharmacological stimuli. 102 prepubertal short patients aged 2 to 17 years with height between 2 to 6 SD below the mean, were studied. Human growth hormone (hGH) treatment was given only to those patients whose GH response was still below 10 ng/ml after estradiol. Under hGH treatment, their growth rate increased twofold, as much in patients with partial GH deficiency as in those with complete GH deficiency. It is concluded that the lack of GH response after estradiol priming contributes to the assessment of the indication for treatment with hGH. However, since it has not been possible to give this treatment to very short children whose GH response became normal after priming, this study does not allow to preclude the effect of hGH in such conditions. Thus estradiol priming must not be included among the practical criteria leading to therapeutic decision in doubtful cases.

[Final results of treatment with human growth hormone]. / Résultats à terme des traitements par l'hormone de croissance humaine.

The authors report the results of treatment with human growth hormone (hGH) (for 3 1/2 years to 11 3/4 years, mean: 5 years 4 months) in 34 children presenting with complete growth hormone deficiency and an average growth failure reaching 3.9 standard deviations (SD). Treatment was discontinued, after spontaneous or induced puberty, when bone age reached or was beyond 15 years in boys, and 13 years in girls. A partial correction was obtained in almost all cases. However, average height remained at -2.4 SD with respect to age and -1.75 with respect to bone age, reaching normal limits in only half of the patients. School and professional performances were not appreciably different from those which are observed in normal adolescents. Although the acceptance of the diagnosis and therapy was not always good, the medical support associated with the supervision of the treatment seems to have had a favourable psychological effect.

[Precocious puberty in boys. Study of a series of 34 cases]. / Les précocités pubertaires des garçons. Etude d'une série de 34 cas.

Thirty-four boys with true precocious puberty were observed: In 28, precocious puberty was related to intracranial causes (17 tumors, 11 other lesions), in 3, it was due to extrapituitary gonadotropin-secreting tumors and in 3 it appeared idiopathic. The clinical development of sex characteristics was slower than the advance of bone age and the increase in hormone levels (plasma testosterone and pituitary gonadotropin reserve as measured by the LH-RH test). Cyproterone treatment seemed more effective than medroxyprogesterone, with respect to both sexual development and evolution of the bone age/height age ratio or the predictable adult height.

Prolactin and thyrotrophin responses to thyroliberin (TRH) in patients with growth hormone deficiency: study in 167 patients.

Both thyrotrophin (TSH) and prolactin (Prl) were studied under thyroliberin (TRH) stimulation tests in 167 hypopituitary dwarfs out of GH or T4 treatment. TSH and/or Prl responses were either low, normal or exaggerated and/or protracted. Various abnormal patterns were observed in most of the patients with low T4 but also in many patients with normal T4. The TSH response should be considered together with the value of T4. A normal response of TSH with a low T4 reflects a relative TSH deficiency from pituitary or hypothalamic origin. There was no clear relationship between the cause or type of hypopituitarism and the pattern of the responses of either TSH or Prl. The abnormalities of TSH and Prl were not related to each other except in patients with a past history of breech delivery. Then both TSH and Prl have to be measured after TRH in order to obtain full information from the test about hypothalamo-pituitary function. The frequency of the exaggerated and/or delayed or protracted responses of TSH and Prl with normal or low T4 is probably mostly related to hypothalamo-pituitary dysfunction. Abnormal responses of TSH or Prl, seldom of both hormones, were observed in otherwise isolated growth hormone (GH) deficiency, leading to a modification of such a diagnosis after the TRH test. Actually, the TRH test may be useful to ascertain the diagnosis of GH deficiency when the GH responses to provocative tests are borderline.