Endocrine Abstracts

We have reported that serum DHEAS increases in growth hormone deficient (GHD) adults with intact ACTH reserve during GH replacement (GHR) in contrast with persisting low levels in ACTH-deficient GHD patients (Isidori et al. Clin Endo 2003:58:601). This was associated with a lower GH dose requirement in ACTH sufficient patients suggesting that DHEA may augment IGF-I generation. We have examined this hypothesis in a double blind placebo controlled trial of 30 hypopituitary female patients on GHR randomised to receive 50mg DHEA or placebo for 6 months. The patients were age matched with a similar duration of disease and number of pituitary deficiencies (16 placebo, 14 DHEA). All but 2 patients were on hydrocortisone replacement and were on a stable dose of GHR, designed to achieve a serum IGF-I between the median and upper part of the age related reference range, for at least 3 months prior to entry into the trial. Serum IGF-I was measured monthly and the dose of GH adjusted if a greater than 15 per cent change from baseline. Two placebo patients were excluded as they had dose adjustments for clinical reasons. 3 patients (1placebo/2 DHEA) withdrew. The DHEA group showed a 14.6 plus/minus 20 per cent (mean plus/minus SD) dose reduction compared with a 1.35 plus/minus 18 per cent dose reduction in the placebo group (p=0.046) resulting in an actual dose reduction of 0.042mg (plus/minus 0.097 SD) compared with 0.008mg (plus/minus 0.084SD) reduction in the placebo group. Serum IGF-I was similar in the 2 groups at the beginning and end of the trial. This study demonstrates that DHEA replacement in female hypopituitary patients enhances the effect of GHR on IGF-I generation and can thereby reduce the dose of GH necessary to achieve an IGF-I in the therapeutic target range.