The relationship between growth hormone (GH) deficiency (GHD) and quality of life (QOL) is coming into sharper focus. Psychological studies of short GHD children referred for GH treatment sometimes show that they have a poor QOL, often due to their feelings of anxiety, depression, social isolation and difficulties maintaining attention. These difficulties may lead to low academic achievement and impoverished interpersonal skills, both of which impact on life satisfaction and productivity. Recent observations suggest that short children who are not referred for medical diagnosis do not experience the same problems. We have observed that after patients are started on GH therapy the incidence of behavioral problems declines to within normal limits on standardized psychometric tests. Pediatric GHD patients are not generally followed closely after growth targets are achieved. Over the past 25 years, several observers have noted that many patients treated with GH in childhood report poor QOL during young adulthood despite achievement of acceptable height and replacement of necessary hormones. They appear, as a group, to be underemployed, often unmarried, and sometimes unhappy. Some have suggested that this may be due to their overprotected early childhood. We have examined a cohort of young adults treated with GH during childhood and found they exhibit symptoms of previously undetected psychiatric disorder. Anxiety, depression, panic disorder and obsessive compulsive disorder were found. Strikingly, the incidence of a particularly disabling anxiety disorder, social phobia, was detected in 38% of one of our groups. This disorder occurs in approximately 13% of the general population. Similar QOL outcomes have been reported in adults who became GHD in later life. We conclude that the spectrum of potential disabilities tied to GHD is broader than previously thought. Management of these patients should include consideration of QOL issues throughout their lifespan. Potential treatment strategies may include continuation of GH therapy as indicated, psychotropic medication, or psychosocial support and rehabilitation.

Journal Section:
Paper
Keywords:
Growth hormone, Behavior, Quality of life, Psychiatric symptoms, Outcome
1.
Money J: Dwarfism: questions and answers in counseling. Rehabil Lit 1967;28:134–138.
[PubMed]
2.
McGauley G, Cuneo R, Saloman F, Sönksen PH: Growth hormone deficiency and quality of life. Horm Res 1996;45:34–37.
[PubMed]
3.
Voss LD: Growth hormone therapy for the short normal child: who needs it and who wants it? The case against growth hormone therapy. J Pediatr 2000;136:103–110.
[PubMed]
4.
Sandberg DE, Brook AE, Campos SP: Short stature: a psychological burden requiring growth hormone therapy? Pediatrics 1994;94:832–840.
[PubMed]
5.
Rotnem D, Genel M, Hintz RL, Cohen DJ: Personality development in children with growth hormone deficiency. J Am Acad Child Psychiatry 1977;16:412–426.
[PubMed]
6.
Underwood LE: The social costs of being short: societal perceptions and biases. Acta Pædiatr Scand Suppl 1991;377:3–8.
7.
Steinhausen H-C, Dorr HG, Kannenberg R, Malin Z: The behavior profile of children and adolescents with short stature. J Dev Behav Pediatr 2000;21:423–428.
[PubMed]
8.
Stabler B, Siegel PT, Clopper RR, Stoppani CE, Compton PG, Underwood LE: Behavior change after growth hormone treatment of short children. J Pediatr 1998;133:366–373.
[PubMed]
9.
Dean HJ, McTaggart TL, Fish DG, Friesen HG: The educational, vocational, and marital status of growth hormone deficient adults treated with growth hormone during childhood. Am J Dis Child 1985;139:1105–1110.
[PubMed]
10.
Mitchell CM, Johanson AJ, Joyce S, Libber S, Plotnik L, Migeon CJ, Blizzard RM: Psychosocial impact of long term growth hormone therapy; in Stabler B, Underwood LE (eds): Slow Grows the Child. Hillsdale, Erlbaum, 1986, pp 97–109.
11.
Clopper RR, MacGillivary MH, Mazur T, Voorhees ML, Mills BJ: Post-treatment follow-up of growth hormone deficient patients: psychosocial status; in Stabler B, Underwood LE (eds): Slow Grows the Child. Hillsdale, Erlbaum, 1986, pp 83–96.
12.
Stabler B, Tancer ME, Ranc J, Underwood LE: Evidence for social phobia and other psychiatric disorders in adults who were growth hormone deficient during childhood. Anxiety 1996;2:86–89.
[PubMed]
https://doi.org/10.1002/(SICI)1522-7154(1996)2:2<86::AID-ANXI4>3.3.CO;2-S
© 2001 S. Karger AG, Basel
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