Psychosocial outcome of children evaluated for short stature
G. D. Zimet, R. Owens, W. Dahms, M. Cutler, M. Litvene and L. Cuttler
Department of Pediatrics, Indiana University School of Medicine, Indianapolis, USA.
OBJECTIVE: To assess the psychosocial functioning of adults who were
evaluated as children for short stature and were not treated with human
growth hormone. DESIGN: Inception cohort study. SETTING: Hospital-based
pediatric endocrinology clinic. PARTICIPANTS: From 1975 to 1980, medical
record review indicated that 181 of the children referred to our clinic for
concerns about short stature were non-growth hormone deficient. In 1992 and
1993, we were able to recruit 35 of these patients for a follow-up study.
Eligible subjects were at least 18 years of age at the time of follow-up.
MAIN OUTCOME MEASURES: Standardized self-report questionnaires assessed
various domains of psychosocial adjustment. Also, a brief test of
intellectual functioning was administered and subjects underwent a
semistructured in-person interview to evaluate pragmatic functioning and
experiences associated with short stature. RESULTS: Few significant
differences between the study sample and standardization samples were found
on measures of psychosocial and intellectual functioning. Within-group
childhood height during the first evaluation appointment was not
significantly associated with most adult measures of psychosocial
adjustment. Shorter adult stature was significantly associated with lower
educational achievement, lower self-esteem, and greater emotional distress.
CONCLUSIONS: The absence of significant psychosocial distress or impairment
in these subjects brings into question one basis for hormonal treatment for
non-growth hormone deficient short stature; that short stature in childhood
is likely to lead to psychological dysfunction in adulthood. The results,
however, also suggest that shorter stature in adulthood may constitute a
psychosocial stressor, increasing vulnerability across several domains.
Clinical practice. Idiopathic short stature.
Lee
NEJM 2006;354:2576-2582.
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Influence of short stature on the change in pulse pressure, systolic and diastolic blood pressure from age 36 to 53 years: an analysis using multilevel models
Langenberg et al.
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Ethical Issues Raised by Expanded Access to Growth Hormone
Mears
AAP Grand Rounds 2004;12:14-15.
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Growth Hormone Treatment for Idiopathic Short Stature: Implications for Practice and Policy
Cuttler and Silvers
Arch Pediatr Adolesc Med 2004;158:108-110.
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Persistent Short Stature, Other Potential Outcomes, and the Effect of Growth Hormone Treatment in Children Who Are Born Small for Gestational Age
Lee et al.
Pediatrics 2003;112:150-162.
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International Small for Gestational Age Advisory Board Consensus Development Conference Statement: Management of Short Children Born Small for Gestational Age, April 24-October 1, 2001
Lee et al.
Pediatrics 2003;111:1253-1261.
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Effect of Growth Hormone Therapy on Height in Children With Idiopathic Short Stature: A Meta-analysis
Finkelstein et al.
Arch Pediatr Adolesc Med 2002;156:230-240.
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Optimizing GH Therapy in Adults and Children
Drake et al.
Endocr. Rev. 2001;22:425-450.
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Controversy: Which children should receive growth hormone treatment
BROOK; et al.
Arch. Dis. Child. 2000;83:176-178.
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