Annerén, Göran, M.D., Ph.D., Uppsala, Sweden
Bull, Marilyn J., M.D., Indianapolis, Indiana
Flórez, Jesús, M.D., Ph.D., Santander, Spain
Guyda, Harvey, J., M.D., Montreal, Canada
Mortimer, Joanne, M.D., Cleveland, Ohio
Pueschel, Siegfried M., M.D., Ph.D., Providence, Rhode Island
Reprinted from Down Syndrome Quarterly, Volume 1,
Number 1, March, 1996|
Dr. Samuel J. Thios, Editor
Granville, OH 43023
Concerning the first issue, there is no good evidence to support the idea that growth hormone deficiency is part of Down syndrome. Although they may show the same variability in growth hormone responses seen in normal children, most children with Down syndrome have normal serum growth hormone levels 2. Thus, consideration of the use of growth hormone in children with Down syndrome cannot be based only upon an expected abnormality of growth hormone secretion. As with all children, those with Down syndrome require close monitoring of growth, and it is important to recognize that they should be monitored using Down syndrome specific growth charts 3. Children whose growth rate deviates from the height growth chart should be referred for evaluation by a pediatric endocrinologist. When children have a proven growth hormone deficiency, a discussion of the risks and benefits of growth hormone treatment should be provided.
The second issue is more difficult since there are few studies that completely address the issue of benefit of treatment with growth hormone in children with Down syndrome. One study of 13 children with Down syndrome has demonstrated increased linear growth and an increase in head circumference following treatment with growth hormone for only one year.4 A long-term followup study on growth hormone treatment also reveals a significant increase in growth.5 A study of 16 children with Down syndrome treated from age 6-9 months for a period of three years revealed growth rate during the treatment period equal to that of children who do not have Down syndrome.6 In this study, there was no significant increase in head circumference. In addition, these same authors recently reported that their preliminary results do not reveal any improvement in motor or mental development in children with Down syndrome who have received growth hormone treatment.7 Neither study has determined the affect on final height on treated patients, nor have the studies discussed possible side effects of growth hormone treatment.
The administration of growth hormone to children with Down syndrome is not standard practice and its use remains investigational. In view of the complex issues involved, it is strongly recommended that parents wishing to consider growth hormone treatment should enroll their child in a proper scientific study.8 Such studies can control for variability in children with Down syndrome, and can include an assessment of behavior and learning in their outcome.
On the basis of the available evidence, and until the recommended scientific studies are completed, the uncontrolled use of hormonal treatments such as growth hormone in children with Down syndrome is not supported by the Down Syndrome Medical Interest Group.
|http://www.denison.edu/collaborations/dsq/growthhormone.html||Revised: May 12, 2000.|