Growth Hormone Therapy and Short Stature‐Related Distress: A Randomized Placebo‐Controlled Trial

Summary

Context

Growth hormone (GH) treatment of short healthy children is based on the belief that short stature is associated with psychosocial problems and a diminished quality of life.

Objective

To determine the impact of GH therapy on psychosocial well‐being and the ability of psychological metrics to define short stature‐related distress.

Methods

Sixty prepubertal boys with idiopathic short stature (age: 10.0±1.4yrs, height‐SDS: ‐2.38±0.3) were enrolled in this four‐year intervention study [one‐year double‐blinded, randomized, placebo‐controlled (GH/placebo‐2:1) and three‐year open‐labeled GH‐therapy]. Explicit (conscious/voluntary) psychological metrics [Pediatric Quality‐of‐Life Inventory (PedsQL), Silhouette Apperception Test (SAT), Rosenberg Self‐Esteem Scale (RSES), Child Behavior Checklist (CBCL)] and implicit (unconscious/involuntary) psychological metrics [Single‐Category Implicit‐Association‐Test for height (SC‐IAT‐H), Height Perception Picture Test (HPPT)]. Psychosocial evaluations were performed at study entry, after one and four years.

Results

At study entry, PedsQL of boys with idiopathic short stature was lower than Israeli norms (P=.001). After one‐year blinded‐intervention only the GH‐treated boys improved their actual and anticipated adult height perception (SAT, P<.001 and P=.022) with reduced short stature‐related distress (SC‐IAT‐H, P<.001). At study end, RSES and SC‐IAT‐H improved significantly (P<.001), with no change in PedsQL and CBCL.

Conclusions

Our finding of improved psychosocial functioning only in the GH‐treated boys after one‐year blinded intervention suggests that it was the GH therapy, rather than being enrolled in a clinical trial, which contributed to the outcome. Long‐term open‐labeled GH‐treatment significantly improved height perception and self‐esteem. Future studies are needed to fully assess the relevance of complementing the routinely used explicit self‐report measures with the implicit measures.

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