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Discontinuing growth hormone therapy is influenced by physiological factors, family preferences, and physician attitudes
The shortest 1.2 percent of U.S. children—for example, 10-year-old boys and girls less than 4'1" tall—are often eligible for growth hormone (GH) treatment. The height goal for therapy is usually average height for a 16-year-old male (68.3") or 14-year-old female (62.6"). A GH-deficient child who has received GH for several years typically shows gradual tapering of growth during mid to late adolescence, signaling decreased potential for growth with continued therapy. However, physician decisions to discontinue GH therapy are not only influenced by physiological factors, but also by family preferences and their own attitudes, according to a study supported in part by the Agency for Healthcare Research and Quality (HS00059).
Researchers analyzed the responses of 188 U.S. pediatric endocrinologists to a survey that included case scenarios of GH-deficient adolescents. On a scale from 5 (high) to 1 (low), factors influencing physician decisions to discontinue GH treatment were: growth velocity 4.24; bone age 4.20; child's wishes 3.43; current height 3.39; parent wishes 2.99; and treatment cost ($26,000 per year for a 48-kg child) 2.58.
Although 33 percent of physicians rarely recommended continuing GH after age 18 (when 99 percent of final height has been attained, leaving under 2 cm of growth remaining), 57 percent disagreed with that. Physicians seemed to value even small gains as the final height goal approached, even though an additional 20 percent expenditure might be needed to gain the last 1 to 3 percent of adult height. Physicians who believed emotional well-being would be impaired by discontinuing GH after linear growth was complete were less likely to terminate GH.
More details are in "Physician decisions to discontinue long-term medications using a two-stage framework: The case of growth hormone therapy," by Leona Cuttler, M.D., J.B. Silvers, Ph.D., Jagdip Singh, Ph.D., and others in the December 2005 Medical Care 43(12), pp. 1185-1193.
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