Psychological Changes in Children Following Growth Hormone Treatment
Presentation Number: MON-0154
Date of Presentation: June 23rd, 2014
Emily C Walvoord*, Ariana H Greene, Jennifer M Katzenstein and Brenna C McDonald
Indiana University School of Medicine, Indianapolis, IN
Substantial debate persists around the idea that using growth hormone (GH) to increase height will correlate with improved psychological adaptation. Additionally, early data suggest that the subtle cognitive problems seen in adults with GH deficiency (GHD) might also occur in children with GHD and improve with treatment. We evaluated cognitive and behavioral status following GH therapy or observation alone in children with GHD and idiopathic short stature (ISS).
Methods: Subjects were 6-16 years old with heights ≤ 3rd percentile for age. GHD was defined as a peak GH level <5 ng/mL. All subjects underwent a targeted neuropsychological test battery at baseline and following 9-12 months of GH therapy. Parents completed the Behavior Assessment System for Children-Second Edition (BASC-2) to assess emotional and behavioral functioning. ANOVA, dependent and independent samples t-tests and chi square tests were used for between and within-group comparisons, as appropriate to the results outlined (SPSS20). GHD subjects treated with GH (N=19) were compared to ISS subjects who were treated (ISS-T, N=9) and not-treated with GH (ISS-NT, N=13). At baseline, GHD subjects were compared to all ISS subjects. Longitudinal analyses compared all three groups (GHD, ISS-T, ISS-NT), and treated vs. untreated subjects (GHD+ISS-T vs. ISS-NT).
Results: Forty-one children (25 boys) had baseline testing; 28 children have completed follow-up testing (19 boys). Mean age at baseline was 11.0 years, (SD = 2.4), with no between-group differences in age, sex, or height SDS. GH-treated children showed a significant improvement in height SDS over time. No clinically meaningful cognitive differences were found between GHD and ISS children at baseline, or between any groups longitudinally. At baseline, no differences were apparent between GHD and ISS subjects on BASC-2 scales. However, longitudinal analyses showed that treated subjects were rated to have worsening depression and withdrawal symptoms over time, while untreated subjects showed lessening of symptoms. Both groups were rated as less anxious at follow-up. When the three groups were compared separately, improvement in anxiety scores was seen for all groups. Both treated groups showed worsening of withdrawal symptoms over time, while the ISS-NT group showed less withdrawal symptoms.
Discussion: GHD and ISS children treated with GH had worsening emotional symptoms over time when compared to children of the same age and height who were not treated with GH. Medical intervention with daily injections, frequent clinic visits and repeated discussions about height might exacerbate instead of improve psychosocial concerns for short, otherwise healthy children. This novel longitudinal study of both the cognitive and emotional effects of GH therapy in GHD and ISS children raises concerns that psychosocial benefits may not be achieved despite improvements in height.
Disclosure: ECW: Principal Investigator, Eli Lilly & Company. Nothing to Disclose: AHG, JMK, BCM