Growth hormone in short children: beyond medicine?

Reproductive medicine and Turner syndrome: ethical issues

This article discusses the ethical issues raised by the medical responses to Turner syndrome (TS). It explores the issues and challenges faced by women with Turner, and by prospective parents of a child with Turner. It focuses on four issues: the use of GH to increase height; the use of third-party oocytes to enable women with Turner to become pregnant; the parental decision to remove and cryopreserve ovarian tissue from a child with Turner; and the termination of fetuses diagnosed with Turner. Many of the challenges associated with TS are directly or indirectly related to social attitudes and practices, from harsh teasing in school to health professionals' assumption that a woman will abort a fetus diagnosed with Turner. All the interventions designed to alleviate the difficulties faced by women with TS should be employed with caution, in part because they raise significant concerns about risk and consent; in part because they offer a medical response to problems that are to some extent social.

Idiopathic short stature: management and growth hormone treatment

In the management of ISS auxological, biochemical, psychosocial and ethical elements have to be considered. In boys with constitutional delay of growth and puberty androgens are effective in increasing height and sexual characteristics, but adult height is unchanged. GH therapy is efficacious in increasing height velocity and adult height, but the inter-individual variation is considerable. The effect on psychosocial status is uncertain. Factors affecting final height gain include GH dose, height deficit in comparison to midparental height, age and first year height velocity. In case of a low predicted adult height at the onset of puberty, addition of a GnRH analogue can be considered. Although GH therapy appears safe, long-term monitoring is recommended.

The views of young adults and their parents on hormone treatment for short stature in adolescence

AIM

To examine the view of young adults and their parents on growth hormone (GH) and gonadotropin-releasing hormone agonist (GnRHa) treatment in adolescence for idiopathic short stature (ISS) or short stature born small for gestational age (SGA).

METHODS

Thirty young adults with ISS or SGA (18 treated, 12 untreated; age 17-23 years; 5.5 years after treatment) completed questionnaires and they and their parents were interviewed.

RESULTS

Self-perceived current psychosocial functioning did not differ between the treated and untreated young adults, but several treated participants perceived psychosocial problems during adolescence. Most treated participants would have chosen again to receive hormone treatment, but they mentioned disadvantages of the treatment and were, as well as untreated participants, reticent upon recommending hormone treatment to others.

CONCLUSION

GH/GnRHa treatment did not appear to have adverse long-term psychosocial consequences and the participants were glad to have taken the opportunity to receive hormone treatment. However, the treated group mentioned several disadvantages of the treatment and perceived some height-related psychosocial problems during adolescence. In considering hormone treatment, the positive as well as the negative aspects of the treatment as perceived by the participants are to be taken into consideration.

Sex differences in patients referred for evaluation of poor growth

OBJECTIVES

The objective of this study was to compare sex differences among referrals for evaluation of poor growth.

STUDY DESIGN

This study was based on chart reviews of all new-patient encounters at Children's Hospital of Philadelphia Diagnostic and Research Growth Center for short stature or poor growth evaluations during 2001. Outcome measures were patient growth characteristics, frequency of underlying pathology, and frequency of laboratory and radiologic investigations before referral.

RESULTS

One hundred eighty-two boys and 96 girls were referred ( P < .0001). Girls were shorter, relative to the general population (median height z score, -2.4 vs -1.9 for boys, P = .02) and mid-parental target heights (median deficit, 1.9 vs 1.3 SD, P < .01). Differences were more pronounced starting at age 9 years. Median time to referral from initial fall-off on the growth curve was 35 months in girls and 24 months in boys (not significant). The percentage of girls (41%) with organic disease significantly exceeded that of boys (15%). Conversely, more boys (72%) than girls (48%) were of normal height or short but healthy ( P < .0001). Sex was not associated with frequency of tests before referral; neither was severity of short stature.

CONCLUSIONS

Sex differences in short stature referrals may delay diagnosis of diseases in girls while promoting overzealous evaluations of healthy boys who do not appear to be tall enough.