Psychosocial Aspects of Young Adult Growth Hormone Deficient Patients Previously Treated with Human Growth Hormone‐ a Preliminary Report

Abstract

Laron, Z., Aran, O., Nofar, E., Beit-Halachmi, N., Pertzelan, A. and Galatzer, A. (Institute of Paediatric and Adolescent Endocrinology, Beilinson Medical Centre, Peta Tikva, Israel). Psychosocial aspects of young adult growth hormone deficient patients previously treated with human growth hormone -a preliminary report. Acta Paediatr Scand [Suppl] 32.5230, 1986.This paper describes a multidisciplinary approach to treating patients with hGH deficiency. The team includes paediatric endocrinologists, social workers and psychologists, and is felt to provide a much better standard of care, producing subjects who are well integrated into society. Key words: Multidisciplinary approach, hGH deficiency.Between 1964 and 1985, we have treated in Israel 166 children with pituitary human growth hormone (hGH) (1). The basic therapeutic approach of our clinic is a multidisciplinary one, that is, the team is composed of paediatric endocrinologists, social workers and psychologists ( 2 ) . Any patient with marked growth disturbance (including hGH deficiency) and his parents are seen regularly by both the physician and one member of the psychosocial team. The initial appraisal includes intellectual evaluation, and is followed by continuing counselling, vocational advice, and discussion with school personnel and later employers.-Up to 1985, 41 of our patients had completed hGH therapy, They comprised 14 with isolated hGH deficiency and 27 with multiple pituitary hormone deficiencies, excluding tumours (3). Comparing the educational level of these patients, those with multiple deficiencies had received fewer years of education, possibly due to their lower socioeconomic class and their relatively lower IQ. Nevertheless, out of 31 patients who have reached diafting age, 42% were accepted for service in non-combatant units; the others were exempted mainly for religious reasons. Out of the 41 patients, none is unemployed, while 10 serve in academic or white collar professions and only 11 are blue collar workers; the others study or are in the army. Many have sexual relationships, though the percentage who are married is lower than in the general population.These hypopituitary patients who have been treated in earlier life with hGH are much better rehabilitated and integrated than the series reported by Blizzard et al. in the USA (4) or Dean et al. in Canada (5). The difference can be explained by the continuous multidisciplinary treatment provided in our clinic, an approach lacking in the other groups. We thus conclude that clinics treating children with chronic growth problems need integrated psychosocial teams in order to succeed in developing not only children with normal stature but happy, useful and productive citizens.A full report of our habilitation and rehabilitation programme for hypopituitary patients will be published elsewhere (6). REFERENCES 1. Laron Z , Josefsberg Z. Withdrawal of human pituitary growth-hormone. Lancet 1985; i: 1324.

The effects of growth hormone and IGF‐1 deficiency on cerebrovascular and brain ageing

“…For instance, adults with childhood onset growth hormone deficiency are more likely to be unemployed (Bjo$ rk et al 1989) and achieve only a junior high school education (Takano et al 1994). Treatment of individuals with childhood onset growth hormone deficiency has been reported to improve measures of intelligence (Sartorio et al 1995) as well as psychosocial measures (Laron et al 1986). These data suggest that growth hormone may impact brain function indirectly by increasing plasma IGF-1 or directly by regulating brain IGF-1 levels.…”

Perceptions of Self and Short Stature: Effects of Two Years of Growth Hormone Treatment

“…The psychological effects of long-tenn treatment with growth hormone (GH) in children with GH deficiency (GHD) remain controversial, with some retrospective studies describing a generally beneficial outcome (5,6). Other studies report less satisfactory outcomes, such as the short child becommg overtly depressed, or parents considering treatment as having failed because of their own unrealistic expectations (7).…”

Growth Hormone Treatment in Adults with Childhood Onset Growth Hormone Deficiency: Effects on Psychological Capabilities

“…These children experience low self-esteem, infantile social behaviour, body image disturbances and a high degree of social isolation [1][2][3][4], The poor social out come of children with GHD might be positively in fluenced by long-term psychosocial counselling started at the time of diagnosis as part of the therapeutic approach [5,6], Nevertheless, a large number of adults with GHD (in particular those who have remained 'shorter' than nor mals) frequently face a persistent disability that may nega tively affect their adult psychosocial development [7][8][9][10]. Up to now, the administration of GH has been strictly reserved for children with GHD and is discontinued once skeletal growth is complete.…”