CHICAGO – In very short children, the slight increase in adult height from growth hormone treatment comes at the cost of psychological well-being, at least at first, according to a prospective cohort study.
So far in the ongoing investigation, the parents of 12 children with growth hormone (GH) deficiency, defined as peak stimulated GH of less than 5 ng/mL, and 7 children with idiopathic short stature (ISS) filled out the Behavior Assessment System for Children, Second Edition (BASC-2) at baseline and after 9-12 months of GH treatment. The results were compared to what the parents of nine ISS children who were not treated reported on the assessment.
Dr. Emily Walvoord
GH-deficient children grew a bit, moving from –2.3 to –1.9 standard deviations below growth chart means, and ISS children grew from –2.6 to –2.2 standard deviations. Untreated children remained about 2.5 standard deviations behind their peers.
There were no statistically significant differences in baseline BASC-2 scores. However, while untreated children improved from a mean baseline depression score of 63 to 55 points, depression scores in treated children rose from 59 to 63 points. Similarly, social withdrawal in untreated children improved from 52 to 47 points, but rose from 54 to 60 points in treated children, lead investigator Dr. Emily Walvoord reported at the joint meeting of the International Congress of Endocrinology and the Endocrine Society.
Scores below 60 are considered nonclinical, scores of 60-65 indicate risk, and scores above 65 indicate pathology, explained Dr. Walvoord, a pediatric endocrinologist at Indiana University in Indianapolis.
"For short, otherwise healthy children, ... daily injections, visits to the endocrinologist every 4-6 months, and repeated discussion [of] their height might exacerbate instead of improve psychosocial concerns about being different. This [study] raises concerns that psychosocial benefits may not be achieved despite improvements in height," she and her colleagues concluded.
"I worry that we are medicalizing these kids. The message we send them is, ‘You’re not okay; there’s something wrong with you because you are too short. So you have to get a shot every day, you have to go see the doctor, and we have to talk about your height all the time.’ That’s the message I worry they internalize," Dr. Walvoord said.
"Are we really helping them? We have to be very careful about what we think is the most important outcome. Is it making the kid an inch or two taller as an adult, or is it that they have better self-esteem and psychological functioning?" she said.
If nothing else, the findings highlight the need to remind children that they are more than a number on a growth curve, and that other things matter in life.
There were no between-group differences in parent-reported cognitive functioning at baseline or follow-up. Anxiety scores improved in both cohorts, falling from 58 to 54 points in treated children, and 52 to 47 in untreated children; the meaning of that finding is uncertain. In addition, "it is possible that there was a bias toward treatment of ISS children who had underlying emotional issues," the investigators noted.
The children in the study were about 11 years old on average, with no significant differences in age, sex, or initial height standard deviations between the two groups.
Dr. Walvoord is gathering results for 13 additional children; of the total 41 subjects, 25 are boys. She hopes to follow the children for more than a year, and split out results for GH-deficient and ISS patients.
Dr. Walvoord and her colleagues had no disclosures. She initiated the work, and Eli Lilly funded it at her request.