Psychosocial Adaptation to Short Stature – An Indication for Growth Hormone Therapy?

Abstract

Although growth hormone does not clearly improve final height in non-growth-hormone-deficient children with short stature, it leads to a temporary acceleration of growth velocity. It is an ongoing discussion whether this effect supports psychosocial adaptation to short stature and therefore could be an indication for growth hormone treatment in children with short stature without growth hormone deficiency. We have reviewed recent literature concerning psychosocial consequences of short stature. Together with own data we can demonstrate that short people regularly adapt well to their height and have a good self-esteem. On the other hand, we focus on the problem that most studies on this subject suffer from methodical problems. A growth-related questionnaire that evaluates subjective and objective perceptions of being short in patients and peers is not at hand. As a consequence, psychosocial problems due to short stature have not been exactly classified yet and therefore do not represent an indication for growth hormone therapy.

Is short stature a problem? The psychological view

“…Nevertheless, it has been claimed that parents, and their children, usually regard the immediate psychological benefits of a short-term increase in growth rate as justifying the treatment, even if the longterm improvement is minimal (77), but there is little evidence to support this notion from the few longitudinal trials to include a psychometric assessment (78)(79)(80). In summary, most commentators agree that GH treatment of ISS or short normal stature cannot be justified (5,81,82).…”

Transcranial Doppler Ultrasonography in the Assessment of Cerebral Circulation Arrest: Improving Sensitivity by Trancervical and Transorbital Carotid Insonation and Serial Examinations

“…In many countries, physicians practice guidelines are available for the determination of brain death [1]. Those guidelines all specify a prerequisite (a known cause of persistent, irreversible, and totally unresponsive comatose state), and comprises a differentialdiagnosis process to exclude states that may mimic brain death (hypothermia, metabolic disorders, drugs, neurologic diseases).…”

“…Those guidelines all specify a prerequisite (a known cause of persistent, irreversible, and totally unresponsive comatose state), and comprises a differentialdiagnosis process to exclude states that may mimic brain death (hypothermia, metabolic disorders, drugs, neurologic diseases). Clinical criteria include: absent motor response, absent brainstem reflexes, and apnea testing, using a PCO 2 target [1][2][3][4][5][6].…”

“…In these situations, ancillary tests may support the diagnosis. Truly confirmatory ancillary tests for brain death should meet the following criteria: (1) There should be no ''false positives'', i.e., when the test confirms ''brain death,'' there should be none who recover or who have the potential to recover. (2) The test should be sufficient on its own to establish that brain death is or is not present.…”

“…Only 28 out of 70 (40%) national practice guidelines, actually, mandate confirmatory testing in patients who meet the neurological standards [1]. Those tests evaluate the electric activity of the brain, the cerebral metabolism or the cerebral blood flow (CBF).…”