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THE SECRETORY DYNAMICS OF GROWTH HORMONE IN PATIENTS WITH CUSHING DISEASE

Growth retardation to complete growth arrest is the hallmark of Cushing syndrome in children. The major mechanism for this has been considered the glucocorticoid-induced resistance of target-tissues to insulin-like growth factor 1 (IGF-1) and other growth factors. The purpose of this study was to examine the growth hormone (GH) secretory dynamics of patients with Cushing disease before and up to 12 months after their cure by transsphenoidal adenomectomy. In fourteen patients, every 20 minutes blood sampling during 24h for determination of plasma GH was performed. These patients also underwent arginine infusion and L-Dopa stimulation tests. Fourteen sex-and pubertal stage- matched normal volunteers were used as controls. Prior to therapy, the patient group had an increased BMI (31.5 ± 5 kg/m2) and markedly decreased plasma 24h GH mean, peak amplitude and peak area values, with pulse frequency similar to that of the controls. GH values after arginine and L-Dopa stimulation were also subnormal in many of these patients with 2 out of 8, and 8 out of 10 failing to show GH responses greater than 7 ng/ml in the respective test. Surprisingly, the same pattern of GH suppression was observed in the patients who were studied 10-11 days, 3 months and 6 to 12 months after their cure, when their BMIs were respectively, relatively stable, 26.9 ± 3.8 kg/m2, and 24.8 ± 3.3 kg/m2. These findings suggest that patients with Cushing disease have marked GH suppression during their illness, which continues for at least a year during their convalescence. We conclude that frank GH deficiency may be another important mechanism for the growth retardation observed in children with Cushing syndrome. In view of the persistent GH suppression after curative removal of the pituitary adenomas, patients should be clinically evaluated for the potential need for GH replacement.