Pituitary Dwarfism: Diagnosis and Treatment*

This is the authors' abstract. We don't add key points for this paper.

Twenty-six cases of pituitary infantilism followed past the age of puberty were analyzed with regard to etiology, sex incidence, time of onset of growth retardation, and frequency of impairment of target-gland function, in an attempt to ascertain whether the diagnosis of pituitaiy insufficiency could have been established before the time of expected sexual maturation. Seven patients had neoplasms in the region of the sella turcica, whereas 19 had idiopathic pituitary insufficiency. There were 5 females and 2 males among the subjects with tumors, but only 1 female among the 19 patients with idiopathic hypopituitarism. The time at which growth retardation became manifest varied but tended to be after the age of 3, and showed itself earlier in the idiopathic cases than in the tumor cases. Studies of target-gland function indicated, apart from growth hormone and gonadotropin deficiency, impairment of thyroid and/or adrenocortical activity in 75 per cent of the cases as judged by serum cholesterol and protein-bound iodine levels, water diuresis, insulin sensitivity and 17-hydroxycorticoid excretion. It is therefore concluded that, when lack of cither thyrotropin or adrenocorticotropin may be inferred from target-organ hypofunction in a dwarfed child, the diagnosis of hypopituitarism can be strongly suspected without awaiting failure of sexual maturation. Psychologic evaluation indicated no dependent relationship between hypopituitarism and I.Q., but a dependent relationship to personality development—personality reflecting the problems concomitant with small stature. The management and available treatment of hypopituitary dwarfism is outlined and early substitution therapy with sex hormones is urged (though not before the usual age of puberty) once the diagnosis is reasonably certain.