Hereditary pituitary dwarfism with spontaneous puberty

An Indian family of hereditary pituitary dwarfism

Three girls and one boy out of six siblings born to parents of consanguineous marriage presented with pituitary dwarfism. Their parents were of normal height. All the affected children had features of classical isolated growth hormone deficiency. No hypoglycaemic attacks were noted. Three of them attained puberty at the age of 16 years.

Roles of age, body weight and composition in the initiation of sexual maturation of Japanese quail (Coturnix coturnix japonica)

1. The roles of chronological age, body weight and body composition in the initiation of sexual maturation of Japanese quail (Coturnix coturnix japonica) were investigated by imposing an inhibitory photoperiod (IP), and by the intramuscular injection of turkey growth hormone (GH) or antisera to turkey growth hormone (AGH). 2. Absence of sexual maturity in the IP treatment was accompanied by reduced testis and ovary-oviduct weights, and an increased breast muscle weight expressed as a proportion of body weight. 3. Antisera to turkey growth hormone (AGH) did not completely inhibit the metabolic activities of endogenous GH. 4. The roles of chronological age, body weight and body composition in the initiation of sexual maturity were inseparable.

Recessively inherited growth hormone deficiency in a family from Iraq

A family from Iraq with five growth hormone deficient children in two closely related sibships is reported. The clinical forms and modes of inheritance of familial growth hormone deficiency are discussed briefly.

Hereditary fibrous hyperplasia of the gingiva with varying penetrance and expressivity

A kindred affected with hereditary fibrous hyperplasia of the gingiva with varying penetrance and expressivity is described. Most of the affected members were short in stature. The pedigree strongly suggested an autosomal dominant mode of inheritance. The penetrance of the trait varied, and three unaffected persons had transmitted the disease to their offspring. There were two modes of expression. The mild form showed only bilateral rugose thickening of the palate, whereas the severe form showed gingival hyperplasia in addition to changes in the palatal mucosa. The changes were already present at birth. Histological examination showed large amounts of alcian blue-positive extracellular material in the subepithelial connective tissue of the hyperplastic mucosa. Loose collagen-poor connective tissue with alcian blue-positive extracellular material and dense collagen-rich connective tissue in the rugose projections of the palatal mucosa were often segregated.

Familial syndrome with panhypopituitarism, hypoplasia of the hypophysis, and poorly developed sella turcica

Two sisters who died at the age of 2.5 years and 5 weeks are described. Both showed signs of panhypopituitarism. At necropsy, no hypophysis could be found in the first child and a rudimentary and partly ectopic hypophysis was found in the other. Both children had a flat, poorly developed sella turcica, and the sellar anomaly could be seen in skull x-rays. These patients represent a hereditary syndrome characterised by neonatal panhypopituitarism, hypoplasia of the pituitary gland, and flat sella turcica.

Aetiology of idiopathic growth hormone deficiency in England and Wales

Information on height, sex, age, and condition of mothers' pregnancy and labour was obtained on all first- and second-degree relatives of 140 cases of idiopathic growth hormone deficiency (GHD). Less detailed information was available for 68 further cases, the two samples together constituting all cases from England and Wales treated under the Medical Research Council Clinical Trial of Human Growth Hormone up till 1974. Compared with the Perinatal Mortality survey of 1958, idiopathic GHD cases showed a significantly greater incidence of breech births (13-7%), of forceps deliveries especially in multiparae (5-6%), and of reported early vaginal bleeding (7-1%). The incidences of breech and forceps were both higher in cases with multiple pituitary hormone deficiency than in cases of 'isolated' GHD. The frequency of either breech or forceps was 43% in multiple and 20% in 'isolated' GHD. Heights of fathers and sibs of affected cases averaged the 50th centile; those of mothers the 35th centile. The ratio of boys to girls affected was 3-8. There were 4 families with more than one member affected; 4-5% of the brothers of probands were themselves affected, 2% of fathers and 1-5% of both sisters and mothers. In the world literature the sex ratio averages about 2-9 with little difference between series; the frequency of breech delivery averages 21% with large differences (2% to 50%) between series. A table of relative risks is given from which a screening procedure may be constructed; following 1% of selected births would give 10% of cases, and 20% of births 50% of cases. We propose a multifactorial aetiology for GHD which brings it into line with malformations such as anencephaly, cleft lip and palate, and pyloric stenosis. An underlying liability to the disease is postulated, continuously distributed in the population and depending on both polygenic and environmental factors among which sex and birth trauma are important. The disease becomes manifest when the liability value reaches a fixed threshold. On this assumption, heritability of idopathic GHD is approximately the same as that of coeliac disease, pyloric stenosis, and patent ductus.

Serum follicular-stimulating hormone and luteinizing hormone as measured by radioimmunoassay correlated with sexual development in hypopituitary subjects

Serum follicular-stimulating hormone (FSH) and luteinizing hormone (LH) as determined by radioimmunoassay, were correlated with sexual development in 29 patients with hypopituitarism (ages 14.2-29.9 yr).16 of 25 idiopathic hypopituitary patients (20 males and 5 females) exhibited some degree of sexual development. Stage III of sexual development or beyond was achieved by 12 of the 16. Of 13 patients with growth hormone (GH), adrenocortical-stimulating hormone (ACTH), and thyroid-stimulating hormone (TSH) deficiency, 8 did not develop beyond stage I. In contrast, five of six patients with GH deficiency without ACTH or TSH deficiency developed to stage III of sexual development or beyond. The mean (+/-sd) serum LH concentration while in stage I (4.3 +/-0.9 mIU/ml) of eight patients (seven males and one female) who developed beyond stage I was significantly (P < 0.005) greater than the mean serum LH concentration (2.3 +/-0.9 mIU/ml) in nine patients (seven males and two females) who had not developed beyond stage I. Mean serum FSH concentrations were not different. Three of four males with organic hypopituitarism did not develop beyond stage I of sexual development. Serum FSH and LH concentrations in the idiopathic and organic hypopituitary patients were more compatible with stage of sexual development than with age. A serum LH concentration below the range of normal for stage I of sexual development in a prepubertal patient suggests that the patient will remain sexually infantile as an adult.

Effect of human growth hormone treatment for 1 to 7 years on growth of 100 children, with growth hormone deficiency, low birthweight, inherited smallness, Turner's syndrome, and other complaints

(1) Human growth hormone (HGH) has been given for one whole year or longer to 100 patients, aged 1·5 to 19 years, participating in the Medical Research Council Clinical Trial of HGH. Each patient was measured 3-monthly for a control year before treatment, and the majority for a control year after the first treatment year. All measurements were made by one anthropometrist. Radiographic measurements of widths of bone, muscle, and fat in calf and upper arm were made. Methods and standards for assessing the significance of a given height acceleration are presented. (2) The characteristics at diagnosis are given of 35 patients with isolated GH deficiency or hyposomatotrophism (HS), 18 with craniopharyngiomas and other CNS lesions, 3 with multiple trophic hormone deficiency, 18 with low birthweight short stature, 4 with hereditary smallness and/or delay in growth, 4 with psychosocial short stature, 1 with high resting HGH and low somatomedin, 6 with Turner's syndrome, and 11 with other diagnoses. (3) 29 of the 35 HS patients were boys and 13 had an abnormally small penis and ill-developed scrotum. Only 2 were sibs. Parents averaged 40th centile for height. 4 children developed growth-suppressing antibodies, and had to cease treatment. The mean standard deviation score (SDS) for height at diagnosis was -4·7, range -2·6 to -7·3. Bone age SDS averaged -3·2, range -0·8 to -5·7. Skinfold SDS averaged +0·91. Limb muscle width SDS averaged about -3·0. GH peak in insulin hypoglycaemia averaged 4·7 ± 0·7 μU/ml, range 1 to 13. (4) A category of partial growth hormone deficiency is defined as patients with GH peaks of 7-20 μU/ml inclusive and height velocity SDS in the year before treatment between -1 and -2. Total HS patients have GH peaks of 1 to 6 μU/ml inclusive and height velocity SDS of < -2. Partial HS patients are accelerated by HGH and should be treated; but their average acceleration is below that of total HS patients. (5) There was a highly significant relation (r = -0·64) between blood GH peak level and pretreatment height velocity in the HS patients. (6) The LBW patients were 10 boys and 7 girls; all the boys had normal genitalia. The average height SDS at diagnosis was -3·7; parents' height centile averaged 50th, bone age SDS -1·8, skinfold SDS -0·9. GH peaks were all above 30