Is Taller Really Better?: Growth Hormone Therapy in Short Children

IS TALLER REALLY BETTER? GROWTH HORMONE THERAPY IN SHORT CHILDREN DOUGLAS S. DIEKEMA* Until the advent of recombinant DNA technology, a limited supply of human growth hormone permitted treatment of only children with documented growth hormone deficiency [1,2]. We now find ourselves with an almost limitless supply of biosynthetic human growth hormone, and parental interest in this newly available and apparently safe technology has grown. It may promise an answer to the prayers of parents with very short children and add a few more inches to the future basketball stars of others. Our society values height, and many parents feel that increased height would offer advantages to their child. Some of these parents have investigated and seized the opportunity to use growth hormone . Yet even though we may be capable of increasing the height of our children, some have paused to consider whether such an activity is morally permissible [3, 4]. And even if permissible, we still must struggle with whether it represents the sort of activity in which we ought to be engaging—as morally responsible people. Moral responsibility requires that we look beyond both the technological question about what we can do and the minimal ethical question about what we may do. Morally responsible people must also ask what we ought to do. In making that determination, we find that several considerations become important. Is Growth Hormone Therapy in the Child's Best Interest"? Most parents who seek growth hormone therapy for their children do so because they believe two things to be true. The first is that growth The author thanks Drs. Norman Fost and David Allen for their critical comments and help in preparing this manuscript. * Department of Pediatrics, University of Washington. Address: 620 Galer Street, #134, Seattle, Washington 98109.© 1990 by The University of Chicago. All rights reserved. 0031-5982/91/3401-0698101.00 Perspectives in Biology and Medicine, 34, 1 ¦ Autumn 1990 \ 109 hormone will make children taller. The second is that being made taller will benefit the child. Both matters deserve closer scrutiny. Does growth hormone effectively increase a child's ultimate height? Good evidence exists that children with growth hormone deficiency experience increased growth velocity and ultimate adult height after treatment with exogenous growth hormone [5-8]. Growth velocity may be increased even further with higher doses of growth hormone [9, 10]. In addition, some children with attenuated growth but apparently normal secretion of growth hormone will respond to exogenously administered growth hormone with increases in growth velocity [11—20]. Children with constitutional growth delay are expected to attain normal adult height, but their growth lags behind that of their peers. They start out shorter, grow at the same rate, and grow for a longer time, thus eventually catching up to their peers in the later teenage years. While these children secrete growth hormone normally, exogenous growth hormone may induce puberty and the pubertal growth spurt [21, 22]. Though the effect on final adult height is unresolved, many feel growth hormone therapy offers a psychological advantage to the child who lags behind his peers in growth and sexual development [23]. The use of growth hormone in children with apparently normal height potential has not been investigated. However, the extraordinary growth associated with pituitary gigantism suggests that large doses of growth hormone might increase the height potential of children with normal height who have normal growth hormone production and function [24-26]. Thus, growth hormone can almost surely increase the ultimate adult height in some short children and, given in large enough doses, could possibly increase the height of normal and even tall children. Yet we still face the question of whether it is in the child's best interest to be made taller. psychological aspects of short stature Overall, children with short stature have normal intelligence. Though they may score lower than their peers on standardized tests, the statistical correlations between height and IQ account for only about 1-5 percent of the total variance in IQ within the population [27, 28]. Likewise, there is no conclusive evidence that short stature per se is associated with decreased levels of academic performance [29—32]. Whether observed correlations between height and academic achievement...