Prepubertal boys with idiopathic short stature who received growth hormone therapy for 4 years experienced an improvement in self-esteem and social functioning when compared with baseline psychosocial health scores, as well as better height perception and a diminished negative attitude toward short stature, according to an analysis of several self-report measures.
“In 2003, the FDA approved GH therapy for children with idiopathic short stature,” Moshe Phillip, MD, professor at the Jesse Z and Sara Lea Shafer Institute for Endocrinology and Diabetes and Schneider Children’s Medical Center of Israel in Petah Tikva, and colleagues wrote in the study background. “It has been assumed that the GH-induced height gain would improve their [quality of life], but the validity of this claim has evoked considerable debate. Some researchers found that children with short stature had lower self-esteem, were more prone to verbal and physical harassment, and that their parents perceived them as having more social problems, while other studies failed to identify any psychopathology or diminished self-esteem in short children as compared with normal-height controls matched for age, sex and social class.”
Phillip and colleagues analyzed data from 60 prepubertal, GH-sufficient boys aged 8 to 13 years with idiopathic short stature (height below –2 standard deviation) enrolled in a 4-year prospective intervention study between October 2011 and April 2017 (mean age, 10 years; mean height-standard deviation score [SDS], –2.38). From baseline to 1 year, boys received either recombinant GH (Genotropin, Pfizer) or placebo, followed by an open-label extension with GH treatment from years 2 to 4. Researchers evaluated boys every 3 months. Primary outcome measures included the changes in scores for the Pediatric Quality of Life Inventory, the Silhouette Apperception Test, the Rosenberg Self-Esteem Scale, the Child Behavior Checklist (completed by parents), the Single-Category Implicit Association Test for Height and the Height Perception Picture Test, analyzed at baseline, 3 months, 1 and 4 years. Researchers used the Pearson correlation coefficient to test for association between height-SDS score and scores for the psychological measures.
At 1 year, boys treated with GH experienced an increase in growth rate and improved height-SDS vs. the placebo-treated group (9.15 vs. 4.54 cm per year and –1.72 vs. –2.23 SD; P < .001 for both).
At 1 year, boys who received GH therapy improved their actual and anticipated adult height perception vs. baseline, according to Silhouette Apperception Test scores (P < .001 and P = .022, respectively) and reported reduced short stature-related distress vs. baseline scores on the Single-Category Implicit Association Test for Height (P < .01).
At 4 years, scores for the Rosenberg Self-Esteem Scale and the Single-Category Implicit Association Test for Height both improved vs. scores at baseline and year 1 (P < .001 for both); however, researchers did not observe changes in scores for the Pediatric Quality of Life Inventory or the Child Behavior Checklist.
“It is noteworthy that intervention with GH therapy did not change the parental perception of their child’s well-being, neither after the 1-year intervention nor at the study end,” the researchers wrote.
The researchers noted that a main study limitation is that most of the positive psychosocial outcomes were demonstrated during the open-label segment of the study, when all participants received GH therapy, and that only 43 of the 60 children participated in all psychosocial evaluations.
“Our findings constitute additional evidence of the social distress experienced by [idiopathic short stature] boys referred to endocrine clinics,” the researchers wrote. “GH treatment in this selected population may have a role not only in increasing height, but also in improving their self-esteem.” – by Regina Schaffer
Disclosure: Phillip reports he has served as an advisory board member for Novo Nordisk and Pfizer and received lecture fees from Sandoz, and his institution received grant support from Novo Nordisk and Pfizer.