Couto-Silva A C, Trivin C, Adan L, Lawson-Body E, Souberbielle J C, Brauner R
Université René Descartes Paris V and Unité d'Endocrinologie Pédiatrique, Hôpital Bicêtre, Assistance Publique-Hopitaux de Paris, France.
J Pediatr Endocrinol Metab. 2005 Aug;18(8):807-13. doi: 10.1515/jpem.2005.18.8.807.
To review the management of boys with short stature and delayed puberty and the testosterone priming protocol.
In 148 boys aged > 14 years seen for height < -2 SDS and constitutional delayed puberty we evaluated growth hormone (GH) secretion and final height (80 boys).
The GH peak was < 10 microg/l after arginine-insulin tests performed with testosterone heptylate priming in 8/32 (25%) and without in 62/153 (41%), including first and second evaluations. It was low in 7/11 boys given 2 x 100 mg testosterone (14.7 +/- 1.7 microg/l) and in 1/21 given 4 x 100 mg (21.3 +/- 2.0 microg/l, p = 0.04). It was low during sleep in 4/29 (14%) boys, all having basal plasma testosterone below 3.5 nmol/l. The basal insulin-like growth factor (IGF)-I concentration was below -2 SDS in 22% of the boys evaluated. Final height was -0.8 +/- 0.1 SDS. It was similar in those with low (n = 9) and normal (n = 71) GH peak, and in those treated (n = 22) or untreated (n = 58) with testosterone. It was over 1 SDS lower than the target height in 20% and than the predicted height at the initial evaluation in 14% of the boys. Pubertal growth was not correlated with the GH peak or plasma IGF-I.
The GH peak during the sleep is more frequently normal than the peak after stimulation. The number of testosterone doses influences the quality of priming. The medical problems involved in treating boys with delayed puberty are excluding disease and deciding on testosterone treatment.
回顾身材矮小且青春期延迟男孩的管理及睾酮激发方案。
对148名年龄大于14岁、身高＜-2 SDS且青春期体质性延迟的男孩进行评估，其中80名男孩评估了生长激素（GH）分泌及最终身高。
在进行精氨酸-胰岛素试验时，使用庚酸睾酮激发的32例中有8例（25%）、未使用的153例中有62例（41%）（包括首次和第二次评估）GH峰值＜10 μg/L。给予2×100 mg睾酮的11例男孩中有7例（14.7±1.7 μg/L）GH峰值低，给予4×100 mg睾酮的21例中有1例（21.3±2.0 μg/L，p = 0.04）GH峰值低。29例男孩中有4例（14%）睡眠期间GH峰值低，所有这些男孩基础血浆睾酮均低于3.5 nmol/L。在评估的男孩中，22%的人基础胰岛素样生长因子（IGF）-I浓度低于-2 SDS。最终身高为-0.8±0.1 SDS。GH峰值低（n = 9）和正常（n = 71）的男孩以及接受（n = 22）或未接受（n = 58）睾酮治疗的男孩最终身高相似。20%的男孩最终身高比目标身高低超过1 SDS，14%的男孩比初始评估时的预测身高低超过1 SDS。青春期生长与GH峰值或血浆IGF-I无关。
睡眠期间的GH峰值比刺激后的峰值更常为正常。睾酮剂量的数量影响激发质量。治疗青春期延迟男孩所涉及的医学问题包括排除疾病和决定是否进行睾酮治疗。
