Growing up with short stature : Psychosocial consequences of hormone treatment

Abstract

Growing up with short stature. Psychosocial consequences of hormone treatment To enhance height in children with short stature, growth hormone (GH) can be used. In short children without a detectable pathology underlying their short stature, there is no medical rationale for growth hormone treatment. In order to justify this treatment in short but otherwise healthy children, it is to be shown that being short is associated with psychosocial problems and that hormone treatment improves psychosocial functioning. In adolescence, better effects on height are expected when growth hormone is combined with a puberty delaying hormone (Gonadotropin Releasing Hormone Agonist, GnRHa). The administration of this hormone makes the evaluation of the psychosocial effects the more important, as pubertal development is temporarily arrested in adolescents who are already disadvantaged because of their height. This thesis examines psychosocial consequences of hormone treatment in short but healthy children. The literature regarding the psychosocial impact of idiopathic short stature (ISS) and effects of hormone treatment on psychosocial functioning in children with ISS was reviewed and discussed. From the literature review it can be concluded that medically referred children with ISS are a subgroup of short children with, on average and according to their parents, more psychosocial problems than their taller peers and than short children who never visited a pediatrician. Psychosocial adaptation probably depends on the presence or absence of risk- and protective factors, but this has hardly been studied. The literature does not provide evidence that GH treatment, which leads to moderate and variable height gain, improves psychosocial functioning in children with ISS. The psychosocial consequences of combined GH and GnRHa treatment in 38 adolescents with ISS or persistent short stature born small for gestational age (SGA) was prospectively examined in a randomized controlled trial. Before GH/GnRHa treatment, the adolescents with ISS or SGA reported normal psychosocial functioning, whereas the parents reported worries about their children's current behavior or future chances in finding a spouse or a proper job. During three years of treatment, indications for some adverse psychosocial consequences in the treated adolescents were found. This suggests that it is useful to monitor psychosocial functioning during a combined GH/GnRHa treatment in adolescents with ISS or SGA. In young adulthood, both treated and untreated participants showed normal psychosocial functioning compared to Dutch population norms. Height gain was on average 2.3 centimeters more for the treated than for the untreated group. It can be concluded that, in the long term and independent of hormone treatment, adequate psychosocial adjustment is expected in case of short stature. The results of this thesis plead against hormone treatment in short normal adolescents. If in the future hormone treatment will lead to more height gain, making a decision for this treatment in an individual child will be a matter of weighing the pros and cons. It is worthwhile to consider psychosocial interventions instead of or as an adjunct to hormone treatment.