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“People called me ‘Shorty.’ I wasn’t too happy about that,” said Lauren Pozmanter. But that was two years ago, when at age 12 she “stood out like a sore thumb,” she said.” Just 4-foot-5, she was one of the shortest kids in her class. Today Pozmanter is a hair’s breadth under 5 feet tall. In jeans, T-short and high wedge heels, she blends in perfectly with the 14-year-old crowd. The East Setauket teenager’s phenomenal growth spurt of almost 7 inches in the past two years is directly attributable to the daily injections of synthetic growth hormone she took from age 12 until her bones fused recently in puberty.
Medical tests done when she was 12 revealed that Pozmanter has a condition known as growth hormone deficiency. Her body does not produce enough growth hormone to stimulate normal growth. Tests done at that time by a pediatric endocrinologist further determined she was not about to grow much taller without medical intervention. Pozmanter’s younger sister and brother, Kristen and Matthew, 9-year-old twins, have been similarly diagnosed. Both have begun to catch up to their peers in height.
“We knew nothing about this condition at all,” said the children’s mother, Lynn, who, like her husband, Murray, is of average height. “Lauren always asked us why she was so short and we would say, “You’ll grow, you’ll grow,’ not knowing she wasn’t going to. This was all news to us. When the pediatrician said, “Go see an endocrinologist, “Lauren had fallen off the growth chart.
Medical science has made it possible for
extremely short, pre-pubescent children who meet certain criteria to have grotwh hormone to grow and develop.
But what constitutes short stature? Who should be treated medically? A decision to administer growth hormone to a child is not made lightly. The drug is given only after extensive tests have determined the need. “The definition of short stature is 2 to 2.5 standard deviations below the mean for their age,” said Dr. Phyllis Speiser, chief of pediatric endocrinology, Schneider Children’s Hospital in New Hyde Park. Standard height charts are compiled by the U.S. Center for Disease Control and Prevention. “But we don’t only look at height. We look at the rate of growth, at genetic potential. We look for an chronic illnesses, we look at nutritional intake and at environment, because psychosocial deprivation can cause growth failure,” Speiser said.
The question revolves around “taking children who are different from others, perhaps, but not necessarily abnormal, and medicalizing their condition by treating them with daily hormone shots,” Speiser said. The Food and Drug Administration has set guidelines as to which children can receive synthetic growth hormone. . . . The FDA also approves synthetic growth hormone for other conditions that cause short stature, including Turner syndrome, chronic renal insufficiency and growth hormone deficiency. In 2003 the FDA added idiopathic short stature to that list. Children with this diagnosis are healthy and produce their own normal levels of growth hormone. But for unknown reasons their height is still more than 2.25 standard deviations below the average for their age and sex.
Although synthetic growth hormone is deemed safe, it can cause side effects and requires careful monitoring. The most common adverse effects in children are headaches and joint pain. Some children have developed scoliosis, curvature of the spine, and it is possible to develop a diabetes-like condition because synthetic growth hormone counteracts the action of insulin the body.
There has been some concern that because children with idiopathic short stature already produce their own growth hormone they may eventually develop cancer because the drug stimulates additional cell growth. But according to Speiser, “There is no clear-cut association between growth hormone and cancer in children. That’s a theoretical concern. We do say there could be additional discoveries in the future of side effects that are unknown at this time.”
If they take growth hormone for a clear-cut indication , then the benefits outweigh the side effect,” she added. Synthetic growth hormone is very expensive, usually costing $20,000 to $40,000 a year, depending on the dosage. In most cases, the cost is borne by medical insurance. Not everyone is eligible.
The approval of idiopathic short stature as a criterion for growth hormone Deficiency has caused some apprehension that it will be misused by overanxious parents who simply want taller children in a culture that typically prizes height. But the specifics for idiopathic short stature are strict enough to discourage such misuse, according to Dr. Mariano Castro-Magana, chief of pediatric endocrinology at Winthrop-University Hospital in Mineola. “People will come with the misconception that they will get growth hormone for their children, but they do not understand the definition of ISS. It’s not for the boy who will be 5 feet 6 inches (in adulthood), but the one who will be 5 fee 3 inches or less, and that makes a big difference.
Naturally, parents worry about how short stature will affect their children’s lives. Patricia Costa of Glen Head is executive director of the Human Growth Foundation. Her daughter, Nicole, who is now 20 years old and 5-foot-2, was “very tiny” as a child. Nicole took growth hormone from age 8 to 13. Short kids, Costa said, have lots of issues. “Riding a bicycle is one. By the time my daughter fit on a tricycle, kids her age were on two-wheelers. Can the child reach a water fountain or the lavatory in school? If they can’t, kids will make fun of them.” She recalled a time when Nicole’s day camp went to an amusement park that had height requirement to go on the rides. Everyone rode except Nicole.
Dr. Catro-Magana agreed that “almost universally” his young patients are “very upset” about being short. However, David E. Sandberg, a researcher at the University of Buffalo, has found differently in his extensive writings about the psychosocial effects of short stature. He recently assessed 956 students of all eights in grades 6 through 12 at a public school upstate. “The kids thought it was a ‘friendship study,” said Sandberg. The results indicated that short students were just as apt to make friends and have peer acceptance as students of average height or taller. Sandberg agreed the majority of short children sent for clinical testing report being teased or juvenilized. “But it would be a mistake,” he said, “to equate that experience with dysfunction. A person can have a negative experience and find ways to compensate, find ways to cope. And that is what we found.
More than 50 years ago, researchers found a way to extract human growth hormone from the pituitary gland of cadavers upon autopsy and successfully used it to stimulate growth in severely short children. However, about 25 years later, it was discovered that a rapidly fatal, dementing disease of the brain – called Creutzfeldt-Jacob disease (CJD) and related to “mad cow disese” – could be transmitted through the human growth hormone. Several young people who had taken the hormone did in fact develop CJD.
Meanwhile pharmaceutical companies were developing a synthetic growth hormone that also is capable of stimulating growth. Since the mid 1980s, only the synthetic growth hormone has been used in this country, available by prescription. . . .
A small number of people who have taken growth hormone as children will continue to do so as adults, under a physician’s care, but in much lesser dosages. Without it they might have problems such as reduced energy, diminished muscle tone, poor bone density, higher cholesterol levels and higher rates of cardiovascular disease. They will not continue to grow because their bones have fused and they are taking a very low dosage.
That said, a black market trade in synthetic hormone has sprung up. Would-be entrepreneurs, who are particularly active on the internet, have touted the drug as an anti-aging Deficiency for the general population and a body builder for athletes, claims that are often misleading and outright deceptive. The Federal Trade Commission has been investigating a number of companies offering what they profess to be synthetic growth hormone. Some of the products offered have been found to not even contain actual growth hormone; others have been found to be improperly handled and not sterile. -
Ellen Mitchell
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