Thursday, March 18, 2010

a short piece on growth hormone

this blog is like a box of chocolates
you never know what you're going to get, right!? (ps: yes, the pun in the title was intentional. i decided on that rather than "growth hormone: a tall tale" because then you might have thought i made all this up!)

while i've spent 5+ years blogging about working in the medical field (with a focus on the *rest* of life), i don't think i've really ever done a truly 'medical' post! i was excited to receive a few requests to provide a recap/summary of my growth hormone presentation from tuesday. so, please excuse this post if you find these kinds of things totally boring!

since i know even the most enthusiastic reader doesn't want to sit through a full recap of my 45 minute talk, i'm going to post 10 slides (the more fun/interesting ones!), and just try to mention some of the high points.

here goes nothing!

growth hormone is a substance released in the brain that can have powerful effects on growth (extra makes growing kids taller) and body composition (decreases fat, builds muscle). the amount naturally present in our bodies sadly decreases as we get older, likely one of the many reasons that careers like this do have a shelf life. also, probably why multiple celebs are rumored to be on the stuff.

so are there any other miracle drugs that can make kids taller? here's a rundown of some of the alternatives. things like testosterone actually are used sometimes to 'jump-start' short and late-developing boys into puberty -- but this strategy is not without risks, as too much can actually make the growth plates fuse earlier (ie, making them shorter in the long run!). sometimes, it's actually advantageous to delay puberty with GnRH agonists such as lupron. unfortunately, all of the available medications have potential risks/benefits. no magic 'grow me' pill yet!

in the talk, i go through various indications for growth hormone - these include growth hormone deficiency (duh), specific disorders like turner's syndrome, chronic renal failure, and prader-willi syndrome, and low birthweight babies. it's also been approved for use in something known as "idiopathic short stature" (described below -- and yes, shawn johnson would qualify!). something that was surprising to me: with a few exceptions, it works in all of these conditions -- at least to some degree -- whether a kid is actually deficient in GH or not!

then i get into some trickier territory. YES -- you can make most short kids taller, typically anywhere from 1-3 inches (it does vary). but does this really make their lives better? there's not lots of evidence to show that it does . . .

although we DO know that heights are correlated with higher incomes (at least initially) and a greater chance of achieving a position of power. check it out: we haven't had a president of average height since jimmy carter in 1976! (we haven't had any women, either, but that's a whole 'nother issue :) )

of course, any medicine comes with risks! in addition to the annoyance of having to get an injection every day (there is no way to give GH as a pill - at least not yet!), there are possible side effects -- increased pressure in the brain that can cause headaches, enlargement of tonsils, and an increase in insulin resistance can occur (although no cases of true diabetes have been attributed to GH).

there's also a potential link with cancer. studies of older patients receiving GH (back in the day when it came from ground up human tissue -- ew!) have revealed a very small increase in the number of cases of colon cancer and hodgkin's disease. studies of patients receiving the synthetic form of GH given today just show an increased risk for second tumors in children that have already had cancer and were treated with radiation.

oh, and the 'self-esteem issues' -- this isn't often addressed, but like it or not, it does send a powerful message to your kid if you are bringing them in to get treated (with shots, no less!) for their shortness.
also, it's expensive. VERY. very!! and of course, insurance coverage varies.

all of this -- and i think the high cost in particular -- raises multiple ethical questions. who should get GH? what are we treating, exactly? is it worth it?

i think these are all important questions to think about. after much thought, i am not "anti-GH", although i was worried i would come off that way. i've seen kids get it and really seem to benefit. especially for those on the very short end of the spectrum -- i mean, i feel like it would be much easier to function in this world at 4'11" compared to say, 4'8".

i also brought up the cultural perspective -- especially to reinforce that standards of what's 'normal' and 'preferred' are relative! it was actually fairly common several decades ago for girls who were going to be tall (as in - 5'9" and up, not 6'5"!) to be treated with estrogen to close their growth plates and prevent this 'undesirable' outcome. i'm sure gabrielle reece wouldn't have appreciated that ONE BIT.

my conclusion slide -- i tried to tie it together by presenting a continuum. some conditions (those who are VERY GH deficient and have other problems in addition to being short) obviously need treatment. those who just want to improve their athletic performance clearly do not. but everyone else exists in a gray area, where cost/benefit/risks really need to be weighed for each individual.

as someone who will be prescribing GH in the future, i feel like doing this research gave me a better perspective! it was a fun topic and very interesting to me. [even if i did whine and complain about having to put it together for weeks on end.]

if you've made it this far, thanks for bearing with this medical-leaning post! i'd love to hear your thoughts . . . especially if you received GH or if it was considered for you!

and no, i did not get GH as a child . . . nor would i have particularly wanted it. i actually don't mind being short, except when i have to go hem my jeans.


Jenny said...Best Blogger Tips[Reply to comment]Best Blogger Templates

Very nice presentation!

I have never come near GH treatment (being 5.10 and a girl) but I know some people who were treated with it. Like all expensive treatments (like the new biologicals for example!) it is of course debatable, and I like your continuum idea. Just being below average height clearly should not be an indication for treatment. If someone is GH deficient on the other hand they should absolutely be treated, since there are other sides to the defiency besides short statue.

Nice to have the presentation over with, right? And what is the next rotation?

sarah said...Best Blogger Tips[Reply to comment]Best Blogger Templates

True story - sometime in early- to mid-adolescence, I tried convincing my parents to give me growth hormone (I was, and still am, 5'). Of course, it was absurd for many reasons, the main one being that they didn't have the money for it. And of course I am now thankful...I wouldn't be any happier at 5'2" now, and still would have to get a stool to reach things on the top shelf. I don't think I even made it into the "gray area". I'm just normal-short, with sometimes normal-short angst.

qwerkyqook said...Best Blogger Tips[Reply to comment]Best Blogger Templates

Nice presentation! I'm glad you posted it, thanks! GH would never have been considered for me. However, my surgery resident told me I was doing an excellent job on the rotation but I REALLY needed to get taller shoes to be taken seriously. She advised me to go buy danskos immediately, and I'm 5ft 5in!

Meg @ Be Fit Be Full said...Best Blogger Tips[Reply to comment]Best Blogger Templates

I have very, very little knowledge on GH so I enjoyed this post! Funny that taller people have higher saleries. Not so funny that my husband is onlt 5'9" and is currently looking for a job!

marathonmaiden said...Best Blogger Tips[Reply to comment]Best Blogger Templates

i loved this post. thanks for it. and women were really treated with estrogen so they wouldnt be as tall? i definitely would have objected as i love my height haha!

loreejo said...Best Blogger Tips[Reply to comment]Best Blogger Templates

really interesting post! both my kids are on the tall-er side and i never thought much of it but growing up they get sooooo many positive remarks for being "so nice and tall", which they had nothing to do with? it always confuses me that they are complimented on it and made me wonder what a shorter statured person must hear? weird that we're so hung up on that and it appears to be so socially acceptable to comment (criticize?)on it. thanks for the "food for thought". and nice presentation!

rosasharona said...Best Blogger Tips[Reply to comment]Best Blogger Templates

Interesting presentation...I think height and how it affects a persons life depends on the individual...i am above average height (especially in the asian community) and despite how revered it iis to be tall in our u.s. culture, i hate being tall! What if after being given gh the kid would have been happy either way? What a waste of money and now the child has increased risks for other diseases...

I'm a believer in working with what cards you're dealt with. I hate my height but that just means i wear flats all the time and DEAL. My feet will thank me later haha.

Chelsea said...Best Blogger Tips[Reply to comment]Best Blogger Templates

Interesting post. Thanks for sharing. One of my favorite parts of my job is when I have an opportunity to learn a little bit about an area of medicine I know nothing about.

Lucy said...Best Blogger Tips[Reply to comment]Best Blogger Templates

Nice presentation, Sarah! And yay for Danskos (as another commenter noted): I, too, can reach a towering 5'5" when I'm wearing them.

Susannah said...Best Blogger Tips[Reply to comment]Best Blogger Templates

So interesting! I think I was particularly shocked by the 1-3" average growth me, that seems so insignificant, and I am 4'9" (and a half, ahem!). I also have to say that I don't think I experienced any of the potential "effects" of being short (i.e. babied by parents, etc) and though it is cliche, I really believe it gave me character (and didn't stop me from marrying a 6'3" man!) But I do think that being short is much, much different for boys. My brother was teased mercilessly--and still is--and I think being short really did affect him in some serious ways. Anyway, thanks so much for the overview, I really enjoyed it!

Jenny said...Best Blogger Tips[Reply to comment]Best Blogger Templates

Oh, I have a question: In the USA, would people have to pay for GH treatment themselves? I am wondering since one commenter said her parents couldn't afford it.

Sharon said...Best Blogger Tips[Reply to comment]Best Blogger Templates

Based on this post, I can tell your talk was awesome! Really interesting.

My entire family is short--even our dogs are tiny, haha. Being 5''2 I used to feel so self conscious when I first starting dating my husband, who is 6''6.

I hate to admit it, but if we have a son, I hope that he's tall. Maybe not freakishly tall like my husband, but not a shrimp like me. I do think height matters for men in our society, and I think it would make life easier for him. That said, everyone has something they need to overcome, right?

sarah (SHU) said...Best Blogger Tips[Reply to comment]Best Blogger Templates

i loved hearing all of your thoughts on height! i think it's interesting that we all seem happy where we are on the height spectrum.

i do completely agree it can be so different for guys. but maybe that will change? after all, 20 years ago i don't think we could have envisioned the emo look being even the slightest bit cool, and yet . . .

finally to answer jenny's question about coverage - it depends on the person's insurance and the indication for use. for GH deficiency, any insurance would cover it (including medicaid, the US-provided insurance that covers low income children). for short stature of other causes -- it really depends. according to my attending, a severely short patient is more likely to have it covered than someone who is just at the cutoff.

who knows? all of this might change quickly with health care reform. and to be honest, i don't have a strongly formed opinion about any of it yet. i do think things need to change, though! but that's a whole other topic!

Tahsin khan said...Best Blogger Tips[Reply to comment]Best Blogger Templates
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