Promoting Adherence to Medical Treatment in Chronic Childhood Illness: Concepts, Methods, and Interventions

By Dennis Drotar | Go to book overview

CHAPTER NINETEEN
Promoting Adherence to Growth
Hormone Therapy Among Children
With Growth Failure

David E. Sandberg
Tom A. Mazur
Rebecca A. Hazen
Dana E. Alliger
John Buchlis
Margaret H. MacGillivray
Children's Hospital of Buffalo, Buffalo, NY

There are numerous causes of short stature ( Lifshitz & Cervantes, 1996). A breakdown by diagnosis of children referred to pediatric endocrinologists for a growth evaluation suggests that approximately half exhibit normal variants of short stature (i.e., height that falls below the conventional cutoff of -2.0 height standard deviations [SDs]), but show normal growth increments that parallel growth channels for the general population ( Lifshitz & Cervantes, 1996; Sandberg, Brook, & Campos, 1994). In the category of pathological causes of short stature, growth hormone deficiency (GHD) stands out as a key endocrinologically based cause of poor growth.

A major objective of growth hormone (GH) therapy is to accelerate growth velocity during childhood and adolescence to achieve an adult height commensurate with estimated genetic potential. Because the sole source of GH prior to 1985 was cadaveric pituitaries, there was never a sufficient supply available to adequately meet the needs of children with GHD. The treatment was therefore restricted to children with the most severe and unequivocal GHD. The diagnosis of GHD was based then, as it is today, on the level of GH released from the pituitary in response to pharmacological stimulation. With the introduction of biosynthetic GH and its unlimited supplies, the GH cutoff for making the diagnosis has crept higher from <3-5 ng/dl to today's conventionally accepted level of <10ng/dl ( Allen, Johanson, & Blizzard, 1996). Although the threshold for initiating treatment has been lowered, current practice remains consistent with the

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