In this prospective longitudinal study, plasma
androgen levels were determined during 1-7 years in 45 patients aged 5.6-23.8 years with either isolated
growth hormone (GH) deficiency or multiple pituitary
hormone deficiencies.
Dehydroepiandrosterone sulfate,
dehydroepiandrosterone, delta 4-androstenedione and
testosterone were measured by RIA in 339 blood samples collected during the study period. Mean plasma
androgen levels are normal in
isolated GH deficiency. Patients with multiple pituitary
hormone deficiencies, but normal
ACTH reserve, have mean levels lower than normal. Patients with multiple deficiencies including
ACTH deficiency have still lower plasma
androgen levels. Longitudinal analysis of the data, however, shows that patients with either
isolated GH deficiency or multiple pituitary deficiencies without
ACTH deficiency constitute a heterogeneous population, with either normal or low to very low plasma
androgen levels. Treatment with human GH as such does not have any effect on the adrenal
androgen secretion. A dissociation is found in some patients between adrenarche and gonadarche, which indicates that the two events are not controlled by the same mechanisms. Our results support the existence of a specific hypothalamic-pituitary adrenal
androgen-stimulating
hormone (AASH).
ACTH, although not identical to AASH, is essential for normal adrenarche. Induced puberty with
estrogens in girls does not influence plasma
androgen levels, and pubic and axillary hair growth is not achieved. It is suggested that replacement treatment with
dehydroepiandrosterone sulfate should be administered to girls with
hypopituitarism and very low plasma
androgen levels at the time of the induction of puberty. Finally, it appears from this study that, to interpret the plasma
androgens in
hypopituitarism, body surface is as good as bone age.