A Plus Side for Human Growth Hormone
Human growth hormone has acquired a bad reputation, thanks to athletes who have abused it in their quest for stardom. But for tens of thousands of children whose growth and development are stymied by a deficiency of growth hormone, daily injections of this biologically synthesized growth stimulant can put them on track toward normality.
I’m not talking about children with normal hormone levels whose genetic heritage will keep them well below the average height for American men and women (respectively, 5 feet 9 inches and just under 5 feet 4), although they, too, can sometimes benefit from an artificial boost from the hormone.
According to Dr. Judith L. Ross, a pediatric endocrinologist at Jefferson University Hospitals in Philadelphia, even hormonally normal children genetically destined to be short can gain one and a half to perhaps four inches in final height, depending on when treatment is begun. Thus, a boy who would otherwise top out at 5 feet 3 could conceivably reach 5 feet 7 through hormone therapy begun at an early age, well before puberty.
But the claims for human growth hormone have been considerably overstated, perhaps because it is such a profitable product, costing tens of thousands of dollars a year — only sometimes covered by insurance. “Many kids who are not actually growth-hormone-deficient will not respond to the treatment, so it is a very expensive crapshoot,” Dr. Philippa Gordon, a pediatrician in Brooklyn, told me in an e-mail message. “What is the psychological fallout when the parents have spent $30,000 a year and the child fails to grow? Also, the long-term side effects are not known.”
Who Can Benefit
Although treatment of hormonally normal children is still highly controversial, therapy is clearly indicated for those with a diagnosed deficiency in growth hormone, which has health benefits beyond height stimulation, according to a report by Dr. Ross and colleagues in the April issue of the journal Pediatrics.
At age 14, Cutler Dozier of Minneapolis was 4 feet 10 inches and weighed 76 pounds, smaller than the average 12-year-old and showing no signs of puberty. His mother, Phyllis Dozier, said she had long thought his size was because of his extremely premature birth. Then, she said in an interview, she learned that “while most preemies eventually catch up, Cutler was falling further and further behind.”
“He was growing only one-quarter to one-half inch a year,” she added, “whereas most children grow about two inches a year.”
Although Cutler’s pediatrician was surprisingly unconcerned, Mrs. Dozier wisely insisted on a referral to a pediatric endocrinologist, who found that Cutler had a serious growth hormone deficiency. He strongly recommended treatment (80 percent of the cost was covered by insurance, leaving the family with a $535 monthly co-payment) and in just one year of daily hormone injections, Cutler grew four and a half inches. His mother said, “At 15, although he was still small for his age, he was finally on the chart for a 15-year-old.”
She added: “Not only did he get taller, his appetite really picked up and his hands grew bigger. He reached 5 feet 4 inches at age 16 but had not yet completed puberty, so the endocrinologist recommended he continue treatment. We left the decision up to Cutler, who decided to continue injecting the hormone for four more years.”
Now 22 and fully grown, Cutler weighs 140 pounds and stands a confident 5 feet 9 inches.
Dr. Ross says that other children who can benefit from growth hormone therapy are those who were born small for their gestational age and who fail to catch up by age 2 or so; girls born with a chromosomal abnormality called Turner syndrome; and children with genetic disorders called SHOX deficiency and Noonan syndrome.
The Pediatrics authors wrote that “short children who were born small for gestational age have relatively large hands and feet and relatively broad shoulders and pelvis.” But six years of hormone therapy can help to normalize their body proportions.
Other conditions still under study for possible benefits from growth hormone therapy include Prader-Willi syndrome, which can result in extreme obesity; cystic fibrosis; and juvenile arthritis that is treated with steroids. In each of these disorders, the researchers reported, growth hormone therapy may improve body composition.
Children who are deficient in growth hormone tend to accumulate body fat, especially around the abdomen, and develop more fragile bones and abnormally low muscle mass. Treating them with the hormone reverses these effects, and results in increased bone density and improved muscle mass in the arms, legs and trunk.
Still, the levels can remain below normal even after six years of treatment. Two studies have shown that further improvement in body composition can result if growth hormone therapy is continued for several years after a child reaches adult height.
The authors reported that discontinuing growth hormone therapy in adolescence would limit the child’s ability to attain “peak bone mass.” They suggested that “growth hormone should be administered in adequate doses and for an adequate length of time to help achieve a bone mineral density within normal range.”
Another potential benefit of continuing treatment throughout adolescence is the effect of growth hormone on a child’s later risk of developing heart disease. In addition to the increase in total body fat and abdominal fat associated with the hormone deficiency, blood levels of low-density-lipoprotein cholesterol (LDL, the so-called bad cholesterol) and triglycerides tend to be abnormally high. Because there is evidence that abnormal lipid levels in early adulthood raise the risk of cardiovascular disease in middle age or later, the Pediatrics authors suggest continuing hormone therapy throughout adolescence.
Are There Risks?
As Dr. Gordon noted, the long-term effects of growth hormone therapy are not known, particularly for children whose hormone levels are normal to begin with. There has been some concern that IGF-1, a protein produced by the liver that mediates the action of growth hormone, may raise the risk of developing cancer. When the hormone is administered, IGF-1 levels rise.
Dr. Ross said that “we monitor the levels of IGF-1 in children treated with growth hormone and adjust the dose so that IGF-1 stays within normal range.” Thus far, she said, there has been no evidence of an increased risk of cancer recurrence in children with leukemia who were treated with growth hormone, although there has been a slight increase in recurrence in children with brain tumors.
The original article can be found at www.nytimes.com
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