Then and Now: This Month in Endocrine History
Submitted by Evan Graber, DO
In 1958, in a Letter to the Editor of the Journal of Clinical Endocrinology and Metabolism, Dr. Raben reported on the first use of human growth hormone (GH) in a patient with hypopituitarism. The method for extracting GH from human pituitary glands had just been reported the year prior. The diagnosis of hypopituitarism was made clinically (stature equal to an average 8 year-old boy, absent puberty) and with laboratory and radiographic studies available at the time (low thyroid 131I uptake and low serum protein-bound iodine, low urinary ketosteroids and absent urinary gonadtropin, skull x-ray to image the sella turcica). The initial bone age was 9 years at the chronological age of 15 years. The patient was treated with U.S.P thyroid (desiccated thyroid extract) and cortisone for 2 years prior to receiving GH.
The patient received 10 months of GH treatment, initially twice weekly and then 3 times weekly when his initial increase in growth rate seemed to wane after 3 months. Injections were given intramuscularly. The growth rate in the last 7 months of treatment was 2.6 inches/year and over the 10 months of treatment; the patient gained 2.1 inches in height (his growth rate was 0.5 inches/year prior to treatment). Dr. Raben demonstrated that GH treatment did not have any effect on the patient’s pubertal development or bone age maturation. There were no adverse side effects.
GH treatment has come a long way since Dr. Raben’s first report. Cadaveric GH has been replaced by recombinant hGH due to technological advances and the unfortunate discovery of Creutzfeld-Jakob disease in several patients treated with pituitary GH. Intramuscular administration has been replaced by subcutaneous injections, and frequency of administration has advanced from daily to the option for weekly injections.