Background: Quality of life (QoL) as it is related with growth hormone deficiency (GHD) is a matter of controversy. Methods: We analyzed QoL in 95 children aged 8–18 years with isolated GHD (72% male) treated with growth hormone (GH). These children were compared to 190 age- and gender-matched healthy children with similar height [height <10th percentile; control group 1 (CG1)] and age- and gender-matched 285 healthy children of normal stature (control group 2: CG2). QoL was measured by the KINDL® questionnaire referring to six domains (physical well-being, emotional well-being, self-esteem, family, friends, and school). Results: QoL was significantly reduced in CG1 (effect-size 0.21) compared to CG2, while QoL was not significantly altered in children with GHD. In multiple linear regression analyses adjusted to age, gender, BMI, migration background, and socioeconomic status, decreasing height-SDS was associated with poorer QoL (especially emotional well-being), and treatment with GH was related significantly to better self-esteem. Increase of height-SDS in children treated with GH was associated positively with QoL and all its subscales except family and school. Conclusions: These findings suggest psychological consequences of short stature in children and an improvement of QoL in children treated with GH with the focus on self-esteem and emotional well-being.

1.
Brutt AL, Sandberg DE, Chaplin J, Wollmann H, Noeker M, Koltowska-Haggstrom M, Bullinger M: Assessment of health-related quality of life and patient satisfaction in children and adolescents with growth hormone deficiency or idiopathic short stature – part 1: a critical evaluation of available tools. Horm Res 2009;72:65–73.
2.
Bullinger M, Brutt AL, Erhart M, Ravens-Sieberer U: Psychometric properties of the KINDL-R questionnaire: results of the BELLA study. Eur Child Adolesc Psychiatry 2008;17(suppl 1):125–132.
3.
Bullinger M, Koltowska-Haggstrom M, Sandberg D, Chaplin J, Wollmann H, Noeker M, Brutt AL: Health-related quality of life of children and adolescents with growth hormone deficiency or idiopathic short stature – part 2: available results and future directions. Horm Res 2009;72:74–81.
4.
Bullinger M: Psychological criteria for treating children with idiopathic short stature. Horm Res Paediatr 2011;76(suppl 3):20–23.
5.
Ravens-Sieberer U, Erhart M, Wille N, Wetzel R, Nickel J, Bullinger M: Generic health-related quality-of-life assessment in children and adolescents: methodological considerations. Pharmacoeconomics 2006;24:1199–1220.
6.
Wille N, Bullinger M, Holl R, Hoffmeister U, Mann R, Goldapp C, Reinehr T, Westenhofer J, Egmond-Froehlich A, Ravens-Sieberer U: Health-related quality of life in overweight and obese youths: results of a multicenter study. Health Qual Life Outcomes 2010;8:36.
7.
Jorgensen AP, Fougner KJ, Ueland T, Gudmundsen O, Burman P, Schreiner T, Bollerslev J: Favorable long-term effects of growth hormone replacement therapy on quality of life, bone metabolism, body composition and lipid levels in patients with adult-onset growth hormone deficiency. Growth Horm IGF Res 2011;21:69–75.
8.
Moock J, Friedrich N, Volzke H, Spielhagen C, Nauck M, Koltowska-Haggstrom M, Buchfelder M, Wallaschofski H, Kohlmann T: Prediction of improvement in quality of life (QoL-AGHDA) in adults with growth hormone deficiency by normative reference limits: data of the German KIMS cohort. Growth Horm IGF Res 2011;21:272–278.
9.
Christensen TL, Djurhuus CB, Clayton P, Christiansen JS: An evaluation of the relationship between adult height and health-related quality of life in the general UK population. Clin Endocrinol (Oxf) 2007;67:407–412.
10.
Ulph F, Betts P, Mulligan J, Stratford RJ: Personality functioning: the influence of stature. Arch Dis Child 2004;89:17–21.
11.
Bannink EM, van Pareren YK, Theunissen NC, Raat H, Mulder PG, Hokken-Koelega AC: Quality of life in adolescents born small for gestational age: does growth hormone make a difference? Horm Res 2005;64:166–174.
12.
Mobbs EJ: The psychological outcome of constitutional delay of growth and puberty. Horm Res 2005;63(suppl 1):1–66.
13.
Sandberg DE, Colsman M: Growth hormone treatment of short stature: status of the quality of life rationale. Horm Res 2005;63:275–283.
14.
Ross JL, Sandberg DE, Rose SR, Leschek EW, Baron J, Chipman JJ, Cassorla FG, Quigley CA, Crowe BJ, Roberts K, Cutler GB Jr: Psychological adaptation in children with idiopathic short stature treated with growth hormone or placebo. J Clin Endocrinol Metab 2004;89:4873–4878.
15.
Norrby U, Nordholm L, Andersson-Gäre B, Fasth A: Health-related quality of life in children diagnosed with asthma, diabetes, juvenile chronic arthritis or short stature. Acta Paediatr 2006;95:450–456.
16.
Sandberg DE: Quality of life and self-esteem in children treated for idiopathic short stature. J Pediatr 2003;143:691.
17.
Voss LD, Wiklund I: Short stature and psychosocial assessment. Acta Paediatr Suppl 1995;411:69–74.
18.
Pilpel D, Leiberman E, Zadik Z, Carel CA: Effect of growth hormone treatment on quality of life of short-stature children. Horm Res 1995;44:1–5.
19.
Erling A, Wiklund I, Albertsson-Wikland K: Prepubertal children with short stature have a different perception of their well-being and stature than their parents. Qual Life Res 1994;3:425–429.
20.
Kurth BM, Kamtsiuris P, Holling H, Schlaud M, Dolle R, Ellert U, Kahl H, Knopf H, Lange M, Mensink GB, Neuhauser H, Rosario AS, Scheidt-Nave C, Schenk L, Schlack R, Stolzenberg H, Thamm M, Thierfelder W, Wolf U: The challenge of comprehensively mapping children’s health in a nation-wide health survey: design of the German KiGGS-Study. BMC Public Health 2008;8:196.
21.
Geisler A, Többens M, Winkel K SA, Reinehr T: Is the prevalence of overweight increasing in primary schooling? A longitudinal analysis of elementary school children in the Vestische Region. Akt Ernährungsmedizin 2011;36:18–22.
22.
Kromeyer-Hauschild K, Wabitsch M, Geller F, Ziegler A, Geiss HC, Hesse V, von Hippel V, Jäger U, Johnson D, Korte W, Kunze D, Menner K, Müller G, Müller M, Niemann-Pilatus A, Remer T, Schäfer F, Wittchen H, Zabransky S, Zelnner K, Hebebrand J: Percentiles of body mass index in children and adolescents evaluated from different regional German studies. Monatsschr Kinderheilkd 2001;149:807–818.
23.
Cole TJ: The LMS method for constructing normalized growth standards. Eur J Clin Nutr 1990;44:45–60.
24.
Ravens-Sieberer U, Redegeld M, Bullinger M: Quality of life after in-patient rehabilitation in children with obesity. Int J Obes Relat Metab Disord 2001;25(suppl 1):S63–S65.
25.
Ravens-Sieberer U, Erhart M, Wille N, Bullinger M: Health-related quality of life in children and adolescents in Germany: results of the BELLA study. Eur Child Adolesc Psychiatry 2008;17(suppl 1):148–156.
26.
Cohen J: Statistical Power Analysis for the Behavioral Sciences, ed 2. Hillsdale, Lawrence Erlbaum Associates Inc., 1988.
27.
Chaplin JE, Kristrom B, Jonsson B, Hagglof B, Tuvemo T, Aronson AS, Dahlgren J, Albertsson-Wikland K: Improvements in behaviour and self-esteem following growth hormone treatment in short prepubertal children. Horm Res Paediatr 2011;75:291–303.
28.
Stephen MD, Varni JW, Limbers CA, Yafi M, Heptulla RA, Renukuntla VS, Bell CS, Brosnan PG: Health-related quality of life and cognitive functioning in pediatric short stature: comparison of growth-hormone-naive, growth-hormone-treated, and healthy samples. Eur J Pediatr 2011;170:351–358.
29.
Lem AJ, Jobse I, van der Kaay DC, de Ridder MA, Raat H, Hokken-Koelega AC: Health-related quality of life in short children born small for gestational age: effects of growth hormone treatment and postponement of puberty. Horm Res Paediatr 2012;77:170–179.
30.
Visser-van BH, Geenen R, Moerbeek M, Stroop R, Kamp GA, Huisman J, Wit JM, Sinnema G: Psychosocial functioning of adolescents with idiopathic short stature or persistent short stature born small for gestational age during three years of combined growth hormone and gonadotropin-releasing hormone agonist treatment. Horm Res 2005;64:77–87.
31.
Bongseog K, Park M: The influence of weight and height status on psychological problems of elementary school children through child behaviour check list. Yonsei Med J 2009;50:340–344.
32.
Visser-van BH, Geenen R, Kamp GA, Huisman J, Wit JM, Sinnema G: Long-term psychosocial consequences of hormone treatment for short stature. Acta Paediatr 2007;96:715–719.
33.
Lee JM, Appugliese D, Coleman SM, Kaciroti N, Corwyn RF, Bradley RH, Sandberg DE, Lumeng JC: Short stature in a population-based cohort: social, emotional, and behavioral functioning. Pediatrics 2009;124:903–910.
34.
Schwimmer JB, Burwinkle TM, Varni JW: Health-related quality of life of severely obese children and adolescents. JAMA 2003;289:1813–1819.
35.
Hughes AR, Farewell K, Harris D, Reilly JJ: Quality of life in a clinical sample of obese children. Int J Obes (Lond) 2007;31:39–44.
36.
Pinhas-Hamiel O, Singer S, Pilpel N, Fradkin A, Modan D, Reichman B: Health-related quality of life among children and adolescents: associations with obesity. Int J Obes (Lond) 2006;30:267–272.
37.
Williams J, Wake M, Hesketh K, Maher E, Waters E: Health-related quality of life of overweight and obese children. JAMA 2005;293:70–76.
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.