The effect of cyproheptadine and human growth hormone on adrenocortical function in children with hypopituitarism
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Cyproheptadine combined with growth hormone may decrease adrenal reserve in children with hypopituitarism. This finding suggests a potential mechanism for enhanced growth observed in these patients during combined therapy.
Area of Science:
- Pediatric Endocrinology
- Endocrinology
- Growth Hormone Therapy
Background:
- Hypopituitarism affects growth and hormonal balance in children.
- Growth hormone (hGH) therapy is standard for growth enhancement.
- Cyproheptadine (CPH) has been anecdotally reported to enhance hGH efficacy.
Purpose of the Study:
- To investigate the effect of combined growth hormone (hGH) and cyproheptadine (CPH) therapy on cortisol response to insulin hypoglycemia in children with hypopituitarism.
- To assess the impact of CPH on adrenocortical reserve.
Main Methods:
- Cortisol response to insulin hypoglycemia was measured in two groups of hypopituitary children.
- Group 1: treated with hGH and CPH for 4 months.
- Group 2: treated with hGH alone for 4 months.
- Patients were retested after CPH cessation.
Main Results:
- Children on hGH alone showed no change in cortisol response.
- Five of ten children on combined hGH and CPH therapy exhibited a subnormal cortisol response.
- This subnormal response normalized in most patients after CPH discontinuation.
- No clinical signs of glucocorticoid insufficiency were observed.
Conclusions:
- Long-term cyproheptadine administration may decrease adrenocortical reserve in hypopituitary children.
- This effect on cortisol production might contribute to the growth-enhancing effects of combined hGH and CPH therapy.
Abstract:
The cortisol response to insulin hypoglycemia was determined in ten hypopituitary children treated for four months with both growth hormone and cyproheptadine, and in six other children with hypopituitarism treated for four months with hGH alone. All patients had previously normal responses to orally administered metyrapone. There was no demonstrable difference in the F responses to insulin hypoglycemia before and four months following its discontinuation in the patients receiving hGH alone. In the ten patients on combined therapy the F response to insulin hypoglycemia was normal in five and subnormal in five patients. These ten patients were retested at least two months after cessation of CPH therapy. The F response reverted to normal in four of the five patients in whom it had been subnormal. There was no significant change in the five patients with initial normal response. No patients had signs or symptoms of glucocorticoid insufficiency. In some cases, long-term administration of CPH to children with hypopituitarism is associated with decreased F response to insulin hypoglycemia; this may represent decreased adrenocortical reserve in these patients. The previously reported enhancement of growth of hypopituitary children treated with hGH and CPH may in part be a result of decreased F production.