Growth Hormone Therapy for a Child With Severe Cognitive Impairment

Doctors and parents face a tough ethical dilemma in deciding whether to initiate GH therapy for a child with ISS and cognitive impairment. The expansion of growth hormone therapy over the last 3 decades has allowed for treatment of short stature for more children, resulting in increased height for many. However, treatment of idiopathic short stature remains controversial. Treatment decisions for disabled children with idiopathic short stature are even more complicated. We discuss a specific case of short stature in a disabled child and grapple with the ethical issues involved in the use of growth hormone.

[1]  D. Allen.  Growth Promotion Ethics and the Challenge to Resist Cosmetic Endocrinology
 , 2017, Hormone Research in Paediatrics.

[2]  D. Opel.  A Push for Progress With Shared Decision-making in Pediatrics , 2017, Pediatrics.

[3]  C. Polychronakos,et al.  Guidelines for Growth Hormone and Insulin-Like Growth Factor-I Treatment in Children and Adolescents: Growth Hormone Deficiency, Idiopathic Short Stature, and Primary Insulin-Like Growth Factor-I Deficiency , 2016, Hormone Research in Paediatrics.

[4]  N. Mauras,et al.  Randomized Trial of Aromatase Inhibitors, Growth Hormone, or Combination in Pubertal Boys with Idiopathic, Short Stature. , 2016, The Journal of clinical endocrinology and metabolism.

[5]  D. Dunger,et al.  GH safety workshop position paper: a critical appraisal of recombinant human GH therapy in children and adults , 2015, European journal of endocrinology.

[6]  M. Gardner,et al.  Short Stature: Is It a Psychosocial Problem and Does Changing Height Matter? , 2015, Pediatric clinics of North America.

[7]  L. Prosser,et al.  An emerging field of research: challenges in pediatric decision making , 2015 .

[8]  M. Bullinger,et al.  Understanding the impact of statural height on health-related quality of life in German adolescents: a population-based analysis , 2015, European Journal of Pediatrics.

[9]  C. Vulpoi,et al.  ETHICAL ISSUES RELATED TO THE USE OF HUMAN GROWTH HORMONE IN IDIOPATHIC SHORT STATURE , 2014 .

[10]  L. Cuttler,et al.  Clinical practice. Short stature in childhood--challenges and choices. , 2013, The New England journal of medicine.

[11]  D. Wilkinson,et al.  Debate: Idiopathic short stature should be treated with growth hormone , 2013, Journal of paediatrics and child health.

[12]  D. Sandberg,et al.  Warning about Warnings: Weighing Risk and Benefit When Information Is in a State of Flux , 2013, Hormone Research in Paediatrics.

[13]  N. Speybroeck,et al.  Long-term mortality and causes of death in isolated GHD, ISS, and SGA patients treated with recombinant growth hormone during childhood in Belgium, The Netherlands, and Sweden: preliminary report of 3 countries participating in the EU SAGhE study. , 2012, The Journal of clinical endocrinology and metabolism.

[14]  E. Eugster.  Long-Term Mortality after Recombinant Growth Hormone Treatment for Isolated Growth Hormone Deficiency or Childhood Short Stature: Preliminary Report of the French SAGhE Study , 2012 .

[15]  D. Allen.  Clinical review: Lessons learned from the hGH era. , 2011, The Journal of clinical endocrinology and metabolism.

[16]  M. Bullinger.  Psychological Criteria for Treating Children with Idiopathic Short Stature , 2011, Hormone Research in Paediatrics.

[17]  A. Deodati,et al.  Impact of growth hormone therapy on adult height of children with idiopathic short stature: systematic review , 2011, BMJ : British Medical Journal.

[18]  H. Bauchner,et al.  Variation in Methods of Predicting Adult Height for Children With Idiopathic Short Stature , 2010, Pediatrics.

[19]  A. Connors,et al.  A National Study of Physician Recommendations to Initiate and Discontinue Growth Hormone for Short Stature , 2010, Pediatrics.

[20]  Alexander A Kon,et al.  The shared decision-making continuum. , 2010, JAMA.

[21]  L. Cuttler,et al.  Growth hormone and health policy. , 2010, The Journal of clinical endocrinology and metabolism.

[22]  M. Savage,et al.  The continuum of growth hormone–IGF‐I axis defects causing short stature: diagnostic and therapeutic challenges , 2009, Clinical endocrinology.

[23]  K. Parker,et al.  Long-term safety of recombinant human growth hormone in children. , 2010, The Journal of clinical endocrinology and metabolism.

[24]  A. Connors,et al.  Patient, Physician, and Consumer Drivers: Referrals for Short Stature and Access to Specialty Drugs , 2009, Medical care.

[25]  T. Speroff,et al.  Effect of growth hormone therapy on height in children with idiopathic short stature: a meta-analysis. , 2002, Archives of pediatrics & adolescent medicine.

[26]  L. Hunt,et al.  Perceived versus Measured Height , 2000, Hormone Research in Paediatrics.

[27]  N. Mauras,et al.  High dose recombinant human growth hormone (GH) treatment of GH-deficient patients in puberty increases near-final height: a randomized, multicenter trial. Genentech, Inc., Cooperative Study Group. , 2000, The Journal of clinical endocrinology and metabolism.

[28]  N. Daniels.  Normal Functioning and the Treatment-Enhancement Distinction , 2000, Cambridge Quarterly of Healthcare Ethics.

[29]  G. Pence.  Classic Works in Medical Ethics: Core Philosophical Readings , 1997 .

[30]  R. Hintz.  Growth hormone treatment of idiopathic short stature. , 1996, Hormone research.

[31]  C. Carella,et al.  Body composition, bone metabolism, and heart structure and function in growth hormone (GH)-deficient adults before and after GH replacement therapy at low doses. , 1993, The Journal of clinical endocrinology and metabolism.

[32]  N. Fost,et al.  Growth hormone therapy for short stature: panacea or Pandora's box? , 1990, The Journal of pediatrics.