Pubertal growth and final height in hypopituitary boys: a minor role of bone age at onset of puberty

Twenty-two hypopituitary boys treated with human GH were studied longitudinally before and during puberty. Eight patients entered spontaneous puberty at a mean bone age of 12.4 ± 1.0 (±SD) yr. Height velocity reached a mean peakof 6.8 cm/yr during the second year of spontaneous puberty. In these patients, the mean total height gain throughout puberty was 22.8 ± 5.2cm, and the mean final height was 158.6 ± 7.2 cm. Fourteen patients received testosterone enanthate (100 mg/month, im) starting at a mean bone age of 13.6 ± 1.1 yr. Height velocity was maximal (7.5 cm/yr) during the first year of therapy. The mean final height was 162.9 ± 5.0cm, with a mean pubertal gain of 15.9 ± 3.8cm. Genital development, peak height velocity, and increase in plasma testosterone levels occurred earlier during testosterone therapy than during spontaneous puberty. In both groups of patients, there was apositive correlation between the bone age at onset of puberty and the height at onset of puberty (r = 0.65). There was also a negative correlation between bone age and total pubertalheight gain (r = −0.73). This reduction inpubertal height increase wasless than expected for bone age at onset of puberty, which can be explained by a decrease in bone age velocity in relation tobone ageat onsetof puberty (r = −0.81). Therefore, advancement in bone age at the onset of testosterone therapy did no timpair final height, whereas it may increase height at onset of puberty, which is the major factor in final height. We conclude that in GH-and gonadotropin-deficient boys 1) a reduced dosage of testosterone enanthate (25 mg twice a month, im) should be used to induce pubertal development, and 2) the major criterion to decide when to give testosterone is height reached at that time regardless of bone age.