Adrenal Androgens in Children with Short Stature

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Abstract
Recent data suggest that adolescent individuals with growth hormone (GH) deficiency have subnormal levels of adrenal androgens (AA). In order to determine the developmental pattern of AA in GH deficiency and to assess whether AA levels can help identify children with GH deficiency, we measured plasma concentrations of dehydroepiandrosterone (DHEA), DHEA sulfate (DHEA-S), .DELTA.4-androstenedione (.DELTA.4A), and cortisol in the basal state and during prolonged adrenocorticotropin (ACTH) infusion (8 h) in a group of 34 individuals, 26 males and 8 females, with short stature. Their chronological ages (CA) ranged from 1.75 to 17.5 years (median 10.35 years). The subjects were grouped into two categories according to the results of pituitary testing: group 1 = short, non-GH-deficient (n = 16), and group 2 = GH-deficient, ACTH-sufficient (n = 18). Patients in groups 1 and 2 had similar bone ages (BA: 7.2 .+-. 0.7 vs. 7.5 .+-. 1.0 years) and Z scores for height (-3.0 .+-. 0.2 vs. -3.2 .+-. 0.3 units) and height velocity (-2.5 .+-. 0.4 vs. -2.6 .+-. 0.2 units). For both groups there were significant increases from basal to peak levels for DHEA, DHEA-S, .DELTA.4A and cortisol following prolonged ACTH infusion. Although both basal and peak levels of DHEA-S overlapped in groups 1 and 2 for all CA and BA, levels in group 2 tended to be lower, especially for BA greater than 10 years. Analysis of covariance showed a significant difference in the slopes of the regression lines of DHEA-S between groups 1 and 2 (basal vs. CA: F 4.9, p < 0.05; basal vs. BA: F 9.7, p < 0.005; peak vs. BA; F 8.7, p < 0.01). There were no differences noted between groups 1 and 2 for DHEA and .DELTA.4A, either in the basal state or after ACTH stimulation. Stimualted values of cortisol were similar for groups 1 and 2 (1,180 .+-. 40 vs. 1,300 .+-. 70 nmol/l). We conclude that, although differences in the overall pattern of DHEA-S between endocrinologically normal short individuals and those with GH deficiency were significant, measurements of AA in the age group studied are not helpful in the differential diagnosis of children with short stature.

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