Growth hormone treatment and health‐related quality of life in children and adolescents: A national, prospective, one‐year controlled study

Abstract

Background Health‐related quality of life (HRQOL) may improve as an additional benefit of the growth hormone treatment (GHT) in children with short stature, but this effect has not been conclusively proven. Objectives To explore the direct effect of GHT on HRQOL in children starting GHT due to isolated or multiple GH deficiency (IGHD), acquired GH deficiency (AGHD) and Turner syndrome (TS), in comparison with untreated short stature controls in 18 UK centres. Methods We used recognized measures of HRQOL, the PedsQL, the Strengths and Difficulties Questionnaire and Youth Life Optimism Test scales to investigate the effect of GHT at 0, 6 and 12 months in children and adolescents 6‐16 years with IGHD (n = 73) and AGHD (n = 45), and 22 girls with TS. 49 children with non‐GHD short stature served as the controls. Results Children rated their HRQOL better than their parents. Those with IGHD and TS rated their overall HRQOL lower than the controls at baseline, psychosocial scores significantly lower in IGHD. After 12 months, the control and TS groups scored higher than UK norms. Those with AGHD had lowest HRQOL scores at all time points, due to poorer physical functioning. The controls showed the greatest improvement in the strength and difficulties scale. All measures evaluated, whether from child, parent or teacher showed an equal improvement over the year of GHT with no discernible direct treatment effect, despite reduced numbers in some patient groups. Conclusions Children with short stature resulting from GHD have lower functioning than controls but HRQOL appears to improve with GHT, most likely on account of greater attention and as a result of the retest phenomenon. We were not able to demonstrate an absolute and independent effect of GHT in itself. HRQOL should not be used as a primary measure, as in adults, to determine whether children should receive GHT.

Psycho-Emotional and Behavioral Problems in Children With Growth Hormone Deficiency

“…Negative social effects of short stature became known; however, the authors of a number of studies consider that short stature as an isolated physical characteristic is not directly related to psychosocial maladjustment ( 12 ). On the other hand, a number of studies have established the role of short stature as a cause of chronic psychosocial stress, impaired psychosocial adaptation, cognitive impairment, poor performance, and reduced intellectual abilities ( 13 ). Many children with chronic disease suffer from distinct emotional, social, and behavioral problems ( 14 ).…”

“…On the other hand, a number of studies have established the role of short stature as a cause of chronic psychosocial stress, impaired psychosocial adaptation, cognitive impairment, poor performance, and reduced intellectual abilities (13). Many children with chronic disease suffer from distinct emotional, social, and behavioral problems (14).…”

Isolated growth hormone deficiency – a rare, but treatable cause of low stature

“…Patients with congenital isolated GHD who do not receive early and regular replacement treatment are prone to lag in achieving normal height and suffer from educational and vocational handicaps (23). Health-related quality of life may improve as an additional benefit of the GH treatment in children with short stature (24).…”

Growth Hormone Deficiency: Is It Just a Problem of Growth Impairment? Part II

“…This specially affects the systolic blood pressure; moreover, since GHD is associated with increased obesity, both factors contribute to increase the risk of future cardiovascular affectations. Quality of life and psychosocial behavior are affected in GHD children and adults [142], usually they are more susceptible to suffer from depression, fatigue, and less physical activity, and all these are improved after GH treatment [143]. GH is also a key modulator of neonatal hypersensitivity and pain-related behaviors during developmental inflammation.…”