Growth Hormone Treatment for Short Stature: Is It Worth the Risks? - Pediatrics

Dr. Wang Jiayi reply Pediatrics

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Dear Concerned Mother,
The desire for children to succeed is a sentiment shared by all parents.
For those with shorter children, concerns about their child's growth may arise.
Height is a subjective measure influenced by psychological factors, making it difficult to establish a definitive standard.
Typically, we use the average height for the same age and sex as a benchmark; a height that falls more than two standard deviations below the average is considered short stature.
Growth rate, whether there is an increase of more than five centimeters per year, and the heights and developmental status of family members are also important considerations.
In addition to nutrition, exercise, and environmental hygiene, genetics plays a crucial role in determining height.
Parents pass on genes that influence height to their children, which is why taller parents often have taller children due to the inheritance of "tall" genes.
However, various factors can complicate this, including chronic illnesses (such as heart disease, uremia, diabetes, or severe anemia), endocrine disorders (such as growth hormone deficiency or hypothyroidism), skeletal development disorders, metabolic diseases (such as mucopolysaccharidosis), and chromosomal abnormalities (such as Down syndrome or Turner syndrome), all of which can affect a child's height.
While there are many potential causes, the majority of short children are considered to have constitutional short stature.
To address concerns about short stature, physicians may conduct simple screenings for the aforementioned causes to identify any underlying medical issues and provide appropriate treatment.
Some conditions associated with short stature are treatable, such as growth hormone deficiency, hypothyroidism, and Turner syndrome, which are described below:
Growth Hormone Deficiency: The pituitary gland secretes various hormones to regulate metabolism, one of which is growth hormone.
This hormone increases blood glucose levels, stimulates tissue growth, enhances protein synthesis, and promotes the release of fatty acids.
A deficiency in growth hormone can lead to abnormal development, resulting in slow increases in height and weight.
Infants with this condition may be slightly shorter than normal at birth and grow at less than half the rate of their peers.
Over time, parents may notice that their child is significantly shorter than others.
These children often have a youthful appearance with a "baby face," and their body fat distribution resembles that of infants.
Radiographic imaging may reveal a bone age that is significantly less than their chronological age.
Approximately one in every four thousand children is affected by this condition, and measuring growth hormone levels can provide a definitive diagnosis.
Hypothyroidism: Thyroid hormones are essential for the development of brain cells in infants.
A deficiency can lead to permanent brain damage.
Causes of hypothyroidism can include abnormal thyroid development, pituitary dysfunction, or ectopic thyroid tissue.
Affected children may exhibit symptoms such as facial dullness, a flattened nasal bridge, dry skin and hair, a hoarse cry, umbilical hernias, jaundice, and growth retardation.
The incidence of this condition is approximately one in three thousand, and early treatment yields better outcomes; if treated within the first three months of life, eighty percent of children can achieve normal cognitive function.
Turner Syndrome: Normally, females have two X chromosomes (males have one X and one Y).
Some girls may end up with only one X chromosome due to errors during meiosis, resulting in Turner syndrome.
This condition presents certain characteristics in infancy, such as a short and broad neck, sometimes resembling a webbed appearance, a wide chest with spaced nipples, and lymphatic edema in the hands and feet, as well as structural abnormalities of the aorta.
While many of these physical features may diminish with age, one characteristic that does not is their stature.
The most significant indicators of Turner syndrome in older girls are short stature and difficulties entering puberty.
The incidence of Turner syndrome is approximately one in five thousand, and chromosomal testing provides the most accurate diagnosis.
Growth hormone can effectively treat the aforementioned conditions; however, it is an expensive medication, and health insurance regulations are strict, meaning not every child seeking to increase their height will be treated with growth hormone.
In fact, the most significant factor influencing a child's height is the height of their parents, and as long as a child's height falls within a reasonable range, it is considered normal and does not necessarily need to be exceptional.
If parents bring their child to see a doctor due to height concerns, it is advisable to bring along the child's height records or request height measurements from the school each semester, as this information can greatly assist the physician in making a diagnosis.
Whether your daughter requires growth hormone therapy will be determined by a pediatric endocrinologist at a medical center after careful evaluation, who will also inform you of all potential side effects.
Please refer to http://www.nhi.gov.tw/information/bbs_detail.asp?menu=1&menu_id=&Bulletin_ID=327 for more information.

Sincerely,
Pediatric Department, Hualien Hospital

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Reply Date: 2007/08/27