Boys with idiopathic short stature more likely to receive GH than girls
Boys with idiopathic short stature are two to three times more likely to receive growth hormone treatment than girls, despite sex not playing a role in the condition, according to research in Scientific Reports.
In a retrospective analysis of medical records from more than two dozen primary care practices in the greater Philadelphia region, researchers found a persistent sex bias in human GH treatment for children with idiopathic short stature (ISS), with young boys outnumbering young girls at every year of age except the first year, and a sharp sex difference peaking during the prepubertal period.
ISS is defined as height more than 2.25 standard deviations below mean for age and sex, without evidence of underlying disease.
“Gender was not a significant predictor of height below the ISS threshold in our primary care population, yet males were 74% of patients treated for ISS and were on average taller at [the] time of GH initiation,” the researchers wrote.
Adda Grimberg, MD, a pediatric endocrinologist at The Children’s Hospital of Philadelphia and senior fellow at the Leonard Davis Institute of Health Economics at the University of Pennsylvania, and colleagues analyzed data from 189,280 children and adolescents aged up to 20 years from 28 primary practices in Pennsylvania, New Jersey and Delaware. Researchers compared that data with 93,736 patients from the four U.S. pediatric GH registries. Researchers converted height/length, weight and BMI to age- and sex-specific percentiles and z scores.
In reviewing the primary care data, researchers found sex was not a significant factor for ISS; male sex had an OR of 0.96 (95% CI, 0.87-1.06).
Researchers found that 66% of patients in the GH registries were boys; 74% of those were treated for ISS. In addition, at the time of ISS treatment initiation, girls were, on average, shorter than boys in each other four GH registries and in all registries combined (mean height z score, –2.8 standard deviation vs. –2.5 standard deviation, respectively; P < .0001).
“Social pressures regarding height seem to affect males more than females, at least in the U.S.,” Grimberg said in a press release. “In the absence of an underlying condition, treating short children with recombinant human [GH] represents medicalization of a physical trait.”
The treatment, Grimberg said, requires daily injections and costs approximately $20,000 annually.
The current study is unique, the researchers said, because it combined data across all four U.S. pediatric GH registries, which are usually analyzed and reported separately due to the proprietary nature of the data.
The researchers noted that both physicians and parents contribute to the gender-based treatment bias.
“Growth failure is a vital sign of child health and should receive equal import for both genders,” the researchers wrote. “By focusing on the social aspects of height, whose pressures seem to affect males more than females in U.S. society, the resultant gender-based biases can lead to missed diagnosis of underlying disease in short girls while promoting overzealous treatment of healthy short boys with an expensive medication.” – by Regina Schaffer
Disclosure: The researchers report no relevant financial disclosures.