Impact of growth hormone (GH) therapy on quality of life along the lifespan of GH-treated patients.

The relationship between growth hormone (GH) deficiency (GHD) and quality of life (QOL) is coming into sharper focus. Psychological studies of short GHD children referred for GH treatment sometimes show that they have a poor QOL, often due to their feelings of anxiety, depression, social isolation and difficulties maintaining attention. These difficulties may lead to low academic achievement and impoverished interpersonal skills, both of which impact on life satisfaction and productivity. Recent observations suggest that short children who are not referred for medical diagnosis do not experience the same problems. We have observed that after patients are started on GH therapy the incidence of behavioral problems declines to within normal limits on standardized psychometric tests. Pediatric GHD patients are not generally followed closely after growth targets are achieved. Over the past 25 years, several observers have noted that many patients treated with GH in childhood report poor QOL during young adulthood despite achievement of acceptable height and replacement of necessary hormones. They appear, as a group, to be underemployed, often unmarried, and sometimes unhappy. Some have suggested that this may be due to their overprotected early childhood. We have examined a cohort of young adults treated with GH during childhood and found they exhibit symptoms of previously undetected psychiatric disorder. Anxiety, depression, panic disorder and obsessive compulsive disorder were found. Strikingly, the incidence of a particularly disabling anxiety disorder, social phobia, was detected in 38% of one of our groups. This disorder occurs in approximately 13% of the general population. Similar QOL outcomes have been reported in adults who became GHD in later life. We conclude that the spectrum of potential disabilities tied to GHD is broader than previously thought. Management of these patients should include consideration of QOL issues throughout their lifespan. Potential treatment strategies may include continuation of GH therapy as indicated, psychotropic medication, or psychosocial support and rehabilitation.