The state of the hypothalamic-pituitary-thyroid system in patients with puberty and youthful dispituitarism

Abstract

Prophylactic check-ups of 6950 adolescents aged 12—18 years and examinations of260 patients with pubertal juvenile dyspituitarism (PJD) were carried out in the Ural region. The incidence of PJD in the Urals has appreciably increased in recent years and now amounts to 96 patients per 1000 adolescents. The incidence of thyroid enlargement in PJD patients is 77.27% vs. 52.8% in the rest adolescents of the city of Perm. Clinical signs of hypothyrosis are observed in patients with PJD. Basal levels of ТТН, T3, T4, and prolactin were normal in the overwhelming majority of PJD patients, but loading tests with thyrotropin-releasing hormone and metoclopramide showed decreased thyroid function caused by hypothalamic involvement and primary thyroid impairment. The regulation of pituitary prolactin-producing function is impaired at the hypothalamic level in PJD patients (dopaminergic control of prolactin secretion is decreased). Psychological dysadaptation to disease is forming in the patients. The need in substitute therapy with thyroid hormones and in psychological correction supplementing pathogenetic therapy for PJD is obvious.