Parent Requests Growth Hormone for Child With Idiopathic Short Stature

Abstract

Cody was always a short child with stature at the 5th percentile of a standard growth curve since he was a toddler. His weight was between the 10th and 25th percentiles. Developmental milestones and early learning achievement were normal. He played in a youth soccer league from 8 to 10 years of age, but he was not enthusiastic about group sports. In middle school, Cody excelled in the sciences and enjoyed tennis and swimming with his friends. In the 7th and 8th grades, his parents reported that Cody was teased frequently about his short stature. When the pediatrician asked Cody about the teasing, he was evasive. Cody’s parents were concerned that experiencing adolescence as the shortest boy in the class would have a lasting negative effect on his self-esteem. His father, remembering his own painful childhood as a short boy who was bullied frequently by other children until late adolescence, read about growth hormone (GH) on the Internet and thought that it might help his son. Cody’s father was 5 ft 5 inches, and his mother was 5 ft 2 inches. His father recalled initiating puberty later than his friends. The paternal grandparents were also short (5 ft 2 inches and 4 ft 8 inches). At the 14-year-old health-supervision visit, Cody’s height was now below the 5th percentile. Review of systems was negative, and he continued to do well in school. Genitalia showed 2.5 cm testes with minimal scrotal thinning, Tanner 2 pubic hair, and no enlargement of the phallus. The thyroid gland was not enlarged; blood pressure and neurological examinations were normal. A bone age was 12 years 6 months (chronological age: 14.0 years). The pediatrician ordered a complete blood count, erythrocyte sedimentation rate, chemistry panel, serum thyroxine, thyroid-stimulating hormone, insulin-like growth factor-1 (IGF-1), and IGF-binding protein-3 (IGFBP-3). All …