Growth hormone therapy and short stature-related distress: A randomized placebo-controlled trial

Moran Shemesh-Iron, Liora Lazar, Yael Lebenthal, Nessia Nagelberg, Ariel Tenenbaum, Revital Ezra, Nir Leffler, Michal Yackobovitch-Gavan, Michal Schoenberg-Taz, Moshe Phillip

Research output: Contribution to journalArticlepeer-review

Abstract

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 ± 1.4 years, height-SDS: −2.38 ± 0.3) were enrolled in this 4-year intervention study (1-year double-blinded, randomized, placebo-controlled [GH/placebo-2:1] and 3-year open-labelled 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 1 and 4 years. Results: At study entry, PedsQL of boys with idiopathic short stature was lower than Israeli norms (P = 0.001). After 1-year blinded intervention, only the GH-treated boys improved their actual and anticipated adult height perception (SAT, P < 0.001 and P = 0.022) with reduced short stature-related distress (SC-IAT-H, P < 0.001). At study end, RSES and SC-IAT-H improved significantly (P < 0.001), with no change in PedsQL and CBCL. Conclusions: Our finding of improved psychosocial functioning only in the GH-treated boys after 1-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-labelled 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.

Original languageEnglish
Pages (from-to)690-701
Number of pages12
JournalClinical Endocrinology
Volume90
Issue number5
DOIs
StatePublished - 1 May 2019

Keywords

  • explicit psychological metrics
  • growth hormone therapy
  • idiopathic short stature
  • implicit psychological metrics
  • psychosocial assessment
  • psychosocial functioning
  • self-esteem

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