Correspondence

Growth Hormone Therapy in Adults and Children

N Engl J Med 2000; 342:359February 3, 2000

Article

To the Editor:

In their review of growth hormone therapy (Oct. 14 issue),1 Vance and Mauras do not mention the abuse of growth hormone by adults. Physicians should be aware that this phenomenon is well documented in athletes.2 Abuse by physicians is also of concern. My organization has intervened in several cases in which physicians have taken growth hormone to increase their sense of well-being and physical performance.

John A. Fromson, M.D.
Massachusetts Medical Society, Waltham, MA 02451

2 References

1. 1

   Vance ML, Mauras N. Growth hormone therapy in adults and children. N Engl J Med 1999;341:1206-1216
   Full Text | Web of Science | Medline

2. 2

   Healy ML, Russell-Jones D. Growth hormone and sport: abuse, potential benefits, and difficulties in detection. Br J Sports Med 1997;31:267-268
   CrossRef | Web of Science | Medline

To the Editor:

Vance and Mauras note that children with Down's syndrome, Noonan's syndrome, the Prader–Willi syndrome, or other conditions may have short stature. If so, should they be denied the benefits of growth hormone therapy? The authors' only stated objection is that no studies have prospectively assessed linear growth in children with these conditions until the achievement of final height. However, as the authors note, growth hormone therapy has not been proved to increase final height in children with chronic renal insufficiency, yet that diagnosis is an approved indication for treatment with growth hormone.

Is growth hormone too expensive to give to children with mental deficiency or developmental defects? Why is growth hormone therapy for children with chronic renal insufficiency or Turner's syndrome — conditions in which only a minority of patients have growth hormone insufficiency — more acceptable than it is for patients whose short stature is associated with other conditions?

Richard A. Levy, M.D.
Rush–Presbyterian–St. Luke's Medical Center, Chicago, IL 60612

Author/Editor Response

The authors reply:

To the Editor: There is no scientific evidence that administration of growth hormone has any beneficial effects in anyone with normal pituitary function. That some physicians take growth hormone is not surprising, since physicians are not immune to the unsubstantiated claims that it improves well-being and physical performance.

The Prader–Willi syndrome, Down's syndrome, and Noonan's syndrome are some of the many congenital conditions that impair linear growth and for which growth hormone therapy has been tried. In children with Down's syndrome, treatment for three years resulted in improved linear growth, but there was no change in either head circumference or intellectual function.1 Children with Noonan's syndrome have had increases in growth in response to growth hormone therapy for up to four years; the responses were intermediate between those in children with idiopathic growth hormone deficiency and those with Turner's syndrome.2,3 In children with the Prader–Willi syndrome, treatment with growth hormone for up to two years resulted in improved linear growth, decreased body fat, and increased lean body mass.4,5 The duration of all these studies was limited, and they were not well controlled. One must be cautious not to raise parental expectations of greater height until the results of large, long-term, well-controlled studies of growth hormone therapy in children with these conditions are available.

Mary Lee Vance, M.D.
University of Virginia Health System, Charlottesville, VA 22908

Nelly Mauras, M.D.
Nemours Children's Clinic, Jacksonville, FL 32207

5 References

1. 1

   Anneren G, Tuvemo T, Carlsson-Skwirut C, et al. Growth hormone treatment in young children with Down's syndrome: effects on growth and psychomotor development. Arch Dis Child 1999;80:334-338
   CrossRef | Web of Science | Medline

2. 2

   De Schepper J, Otten BJ, Francois I, et al. Growth hormone therapy in pre-pubertal children with Noonan syndrome: first year growth response and comparison with Turner syndrome. Acta Paediatr 1997;86:943-946
   CrossRef | Web of Science | Medline

3. 3

   Romano AA, Blethen SL, Dana K, Noto RA. Growth hormone treatment in Noonan syndrome: the National Cooperative Growth Study experience. J Pediatr 1996;128:S18-S21
   CrossRef | Web of Science | Medline

4. 4

   Lindgren AC, Hagenas L, Muller J, et al. Growth hormone treatment of children with Prader-Willi syndrome affects linear growth and body composition favourably. Acta Paediatr 1998;87:28-31
   CrossRef | Web of Science | Medline

5. 5

   Carrel AL, Myers SE, Whitman BY, Allen DB. Growth hormone improves body composition, fat utilization, physical strength and agility, and growth in Prader-Willi syndrome: a controlled study. J Pediatr 1999;134:215-221
   CrossRef | Web of Science | Medline

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