Treatment with growth hormone (GH) in selected boys with short stature may be associated with improved self-esteem and social function in addition to increased height, according to study results published in Clinical Endocrinology.
Although some previous reports found that low self-esteem is common among children with short stature, others could not identify a higher incidence of psychosocial problems in this population compared with in normal-height control children. Similarly, there was inconsistency regarding the effect of GH therapy on emotional and social function in children.
Researchers in Israel aimed to determine the effect of GH therapy on the psychosocial well-being and self-esteem of boys with idiopathic short stature, and to investigate the ability of psychological metrics to define distress related to short stature.
The prospective trial included 60 GH-sufficient, prepubertal, short stature (height below -2 standard deviations) boys aged 8 to 13 years. The trial excluded patients with chronic illness or medications, genetic syndromes, intellectual disability, or psychiatric illness.
This was a 4-year intervention study, including double-blinded, randomized, placebo-controlled treatment with GH or placebo (2:1) for 1 year followed by 3-year open-labeled GH therapy. The primary outcome measures included the Pediatric Quality of Life Inventory, Silhouette Apperception Test, Rosenberg Self Esteem Scale, Child Behavior Checklist, and Height Perception Picture Test. The researchers analyzed the outcomes at study entry, after the first year, and at the end of the study.
The results indicated that at baseline and after the 1-year intervention, total Pediatric Quality of Life Inventory score of boys with idiopathic short stature was significantly lower than that of the healthy population from Israel and the United States. There was no significant difference between scores of children treated with GH or placebo at study entry (76.7 ± 13.0 vs 78.9 ± 10.2, respectively; P =.512) or after 1-year intervention (76.9 ± 11.6 vs 81.4 ± 10.7, respectively; P =.095). At the end of the blinded intervention, Silhouette Apperception Test rating, which measured height perception, significantly increased in the GH-treated group (2.5 ± 0.7; P <.001) but did not change significantly in the placebo-treated group (2.1 ± 0.7; P =.239), indicating that only those treated by GH improved their actual and anticipated adult height perception. However, other psychosocial functions remained unchanged after 1 year of blinded intervention.
At the end of the study, after an additional 3 years of open-label GH treatment, a significant improvement in the self-esteem score was observed in all patients (P <.001). In those who attained near-adult height, there was a marked improvement in social (P =.030) and psychosocial (P =.033) functioning.
The main limitation of this study was the lack of a placebo-control group for the long-term GH treatment. As most of the positive psychosocial outcomes were evident during the open-label part of the trial, when GH therapy was given to all patients, it is not possible to attribute the psychosocial benefit solely to improved height after GH therapy.
“Our findings constitute additional evidence of the social distress experienced by [boys with idiopathic short stature] referred to endocrine clinics. GH treatment in this selected population may have a role not only in increasing height but also in improving their self-esteem,” concluded the researchers.
Please refer to reference for a complete list of authors’ disclosures.
Shemesh-Iron M, Lazar L, Lebenthal Y, et al. Growth hormone therapy and short stature-related distress: a randomized placebo-controlled trial [published online February 5, 2019]. Clin Endocrinol (Oxf). doi:10.1111/cen.13944