Replacement therapy in hypothalamus-pituitary insufficiency: management in the adolescent

GH, formerly administered 2-3 times a week intramuscularly, is nowadays injected daily subcutaneously at a dosage of 14 IU/m2/day. In some patients, a 1.5- to 2.0-fold higher GH dosage is necessary for normal pubertal growth spurt. Though delayed initiation of puberty in additional gonadotropin deficiency may be favourable for final height, puberty should be induced in boys at bone age 12-13 years with low doses of testosterone enanthate, and in girls at bone age 12 years with low doses of ethinyl estradiol. Patients with additional ACTH deficiency should receive only a low-dose glucocorticoid replacement (but a steroid cover for physical stress situations). During GH therapy, thyroid function has to be evaluated regularly; often thyroxine replacement will be necessary.