A prospective, randomized study of testosterone treatment of constitutional delay of growth and development in male adolescents

The physiologic and psychological responses to androgen treatment of constitutional delay of growth and development were prospectively evaluated in 16 male adolescents, aged 14 to 17 years. Subjects were randomly assigned to a course of testosterone enanthate, 200 mg administered intramuscularly four times at three-week intervals or to observation. At one-year follow-up all subjects in the testosterone group exhibited excellent growth: 7.2 to 11.6 cm/yr (mean 9.2 cm/yr). Growth in control subjects was highly variable: 2.6 to 10.6 cm/yr (mean 6.0 cm/yr), significantly lower than that of the testosterone group (P less than .02). The mean annual increment in bone age was 1.1 years for both groups. The delta height age/delta bone age ratio was slightly higher in the testosterone group (1.3 vs 1.1) and the treated subjects had a 1.7-cm increase in predicted adult height. Both groups showed improved self-image, and treated subjects also exhibited dramatic increases in both school-related and extraschool social activity. A brief course of testosterone enanthate appears to be an effective, safe means of promoting growth in select male adolescents.

Familial cytomegalic adrenocortical hypoplasia: an X-linked syndrome of pubertal failure

Five boys with familial cytomegalic adrenocortical hypoplasia have been followed up for an average of 19 years. Despite treatment with replacement corticosteroids, all 5 failed to show a spontaneous onset of puberty and, when assessed at ages 13 to 19 years, all had both sexual infantilism and skeletal immaturity. Hypogonadism was confirmed by low levels of plasma testosterone, and pituitary reserve of gonadotrophin was shown to be inadequate by testing with gonadotrophin-releasing hormone. Two boys, both with adequate testosterone output on human chorionic gonadotrophin stimulation, were given gonadotrophin therapy, whereas the other 3 were treated with parenterally administered testosterone. With treatment, all 5 patients showed advances in pubertal staging. Although the mechanism of the hypogonadotropism remains unclear, the association of hypogonadotrophic hypogonadism with familial cytomegalic adrenocortical hypoplasia appears to be a constant one and may be considered as a treatable inherited syndrome of pubertal failure.

Hypernatraemia, diabetes mellitus, hyperprolactinaemia, retarded growth and delayed puberty in a 14 year old girl. Effect of bromocriptine treatment

Investigations in a 14 year old girl with arrested growth for 2 years, delayed pubertal development, hypernatraemia without thirst, diabetes mellitus and hyperlipaemia are reported. The hypernatraemia was accompanied by a low vasopressin concentration with an abnormal response to thirst, high plasma renin but normal plasma aldosterone concentrations. Treatment with vasopressin and increased fluid intake decreased serum sodium levels. Serum gonadotrophins were low; GH response during an insulin tolerance test was subnormal and basal serum Prl concentration was elevated. Bone age, thyroid function and adrenal function were normal. After initiation of bromocriptine treatment her growth accelerated and regular menstruations commenced. The serum gonadotrophin levels increased and showed pulsatile release. A hypothalamic disorder is suggested, but no cerebral lesion could be demonstrated.

Treatment of anorchia with oral testosterone undecanoate: pharmacodynamics and clinical effectiveness

The pharmacodynamics of plasma testosterone (T) and androstenedione (A) levels were studied in ten hypogonadal boys after oral administration of testosterone undecanoate (TU). Plasma T and A levels were measured by specific radioimmunoassays. Six hours after a single dose of 120 mg TU, there was a significant increase (P < 0.005) in plasma T and A with a median T peak level of 940 ng/100 ml. Furthermore, twelve agonadal boys treated with a mean dose of 60 mg TU/day were examined over a period of 18-24 months. During this therapy, plasma T and A levels were significantly higher than before (P < 0.005), whereas plasma levels of LH and FSH did not decrease significantly. With the exception of one anorchic boy, all patients showed signs of sexual maturation, such as growth of pubic and axillary hair, and steady development of bone age during oral TU treatment.