Methylphenidate and the Response to Growth Hormone Treatment in Short Children Born Small for Gestational Age

Abstract

BackgroundGrowth hormone (GH) treatment has become a frequently applied growth promoting therapy in short children born small for gestational age (SGA). Children born SGA have a higher risk of developing attention deficit hyperactivity disorder (ADHD). Treatment of ADHD with methylphenidate (MP) has greatly increased in recent years, therefore more children are being treated with GH and MP simultaneously. Some studies have found an association between MP treatment and growth deceleration, but data are contradictory.ObjectiveTo explore the effects of MP treatment on growth in GH-treated short SGA childrenMethodsAnthropometric measurements were performed in 78 GH-treated short SGA children (mean age 10.6 yr), 39 of whom were also treated with MP (SGA-GH/MP). The SGA-GH/MP group was compared to 39 SGA-GH treated subjects. They were matched for sex, age and height at start of GH, height SDS at start of MP treatment and target height SDS. Serum insulin-like growth factor-I (IGF-I) and IGF binding protein-3 (IGFBP-3) levels were yearly determined. Growth, serum IGF-I and IGFBP-3 levels during the first three years of treatment were analyzed using repeated measures regression analysis.ResultsThe SGA-GH/MP group had a lower height gain during the first 3 years than the SGA-GH subjects, only significant between 6 and 12 months of MP treatment. After 3 years of MP treatment, the height gain was 0.2 SDS (±0.1 SD) lower in the SGA-GH/MP group (P = 0.17). Adult height was not significantly different between the SGA-GH/MP and SGA-GH group (−1.9 SDS and −1.9 SDS respectively, P = 0.46). Moreover, during the first 3 years of MP treatment IGF-I and IGFBP-3 measurements were similar in both groups.ConclusionMP has some negative effect on growth during the first years in short SGA children treated with GH, but adult height is not affected.

Attention-Deficit/Hyperactivity Disorder Medication Treatment Impact on Response to Growth Hormone Therapy: Results from the ANSWER Program, a Non-Interventional Study

“…Additionally, a study of short SGA children treated with GH with or without methylphenidate treatment for ADHD showed no negative effect of stimulant treatment on adult height. 14 Thus, the potential effects of ADHD stimulant medications on linear growth and weight responses among pediatric GH treatment indications remain to be clarified. The current study examines the effect of ADHD medications on change in height SDS (DHSDS) and change in body mass index (BMI) SDS (DBMI SDS) over a 4-year period of GH therapy in pediatric patients enrolled in the American Norditropin Studies: Web-Enabled Research (ANSWER) Program.…”

Growth perturbations from stimulant medications and inhaled corticosteroids

“…After 3 years, subjects receiving stimulant medication had a 0.2 z-score reduced height gain compared to children not taking stimulant therapy. However, both groups had similar adult heights at −1.9 standard deviation score (22).…”

“…Renes et al investigated a cohort of children born small for gestational age (SGA) receiving GH therapy, with or without stimulant therapy for ADHD (22). The authors compared 39 children treated with GH for SGA and methylphenidate for ADHD to 39 matched children treated with GH for SGA, without ADHD.…”

Stimulant Use and Its Impact on Growth in Children Receiving Growth Hormone Therapy: An Analysis of the KIGS® International Growth Database

“…Alternatively, the lower BMI of former SGA children may cause GH and/or IGF-I resistance that makes them more susceptible to impaired growth due to ADHD with stimulant therapy. In a recent case-control study of GH therapy in SGA children by Renes et al [13], children treated with methylphenidate demonstrated reduced height gain between 6 and 12 months of GH therapy compared to SGA children not receiving methylphenidate (-0.05 SDS). No catch-up growth was seen in the period after stopping methylphenidate therapy; however, there was no long-term negative impact on adult height with methylphenidate treatment in this cohort.…”