Methylphenidate and the response to growth hormone treatment in short children born small for gestational age
Judith S Renes1, Maria A J de Ridder, Petra E Breukhoven
1Department of Pediatrics, Subdivision of Endocrinology, Erasmus MC/Sophia Children's Hospital, Rotterdam, The Netherlands. j.renes@erasmusmc.nl
Insights
Methylphenidate (MP) may slightly slow growth in short children born small for gestational age (SGA) receiving growth hormone (GH) therapy. However, this effect is temporary, and final adult height remains unaffected by MP treatment.
Area of Science:
- Pediatric Endocrinology
- Growth Disorders
- Neurodevelopmental Disorders
Background:
- Short children born small for gestational age (SGA) often receive growth hormone (GH) therapy.
- Attention deficit hyperactivity disorder (ADHD) is more prevalent in SGA children, leading to increased co-prescription of methylphenidate (MP).
- The impact of combined GH and MP treatment on growth is not well-established, with conflicting previous findings.
Purpose of the Study:
- To investigate the effects of methylphenidate (MP) on growth outcomes in children treated with growth hormone (GH).
- Specifically, to assess growth patterns in short SGA children receiving both GH and MP therapy.
Main Methods:
- A cohort of 78 short SGA children on GH therapy was studied.
- 39 children also received methylphenidate (MP) (SGA-GH/MP group), compared to 39 controls (SGA-GH).
- Anthropometric measurements, serum IGF-I, and IGFBP-3 levels were analyzed over three years using regression analysis.
Main Results:
- The SGA-GH/MP group exhibited reduced height gain in the initial years, particularly between 6 and 12 months of MP treatment.
- After three years, height gain was marginally lower (0.2 SDS) in the SGA-GH/MP group, though not statistically significant (P=0.17).
- Adult height and IGF-I/IGFBP-3 levels did not differ significantly between the groups.
Conclusions:
- Methylphenidate (MP) may exert a transient negative effect on growth velocity during the early stages of combined therapy in short SGA children on GH.
- The overall final adult height is not significantly impacted by the addition of MP to GH treatment in this population.
- Long-term monitoring of growth parameters is essential for children receiving concurrent GH and MP therapy.
Background:
Growth hormone (GH) treatment has become a frequently applied growth promoting therapy in short children born small for gestational age (SGA). Children born SGA have a higher risk of developing attention deficit hyperactivity disorder (ADHD). Treatment of ADHD with methylphenidate (MP) has greatly increased in recent years, therefore more children are being treated with GH and MP simultaneously. Some studies have found an association between MP treatment and growth deceleration, but data are contradictory.
Objective:
To explore the effects of MP treatment on growth in GH-treated short SGA children
Methods:
Anthropometric measurements were performed in 78 GH-treated short SGA children (mean age 10.6 yr), 39 of whom were also treated with MP (SGA-GH/MP). The SGA-GH/MP group was compared to 39 SGA-GH treated subjects. They were matched for sex, age and height at start of GH, height SDS at start of MP treatment and target height SDS. Serum insulin-like growth factor-I (IGF-I) and IGF binding protein-3 (IGFBP-3) levels were yearly determined. Growth, serum IGF-I and IGFBP-3 levels during the first three years of treatment were analyzed using repeated measures regression analysis.
Results:
The SGA-GH/MP group had a lower height gain during the first 3 years than the SGA-GH subjects, only significant between 6 and 12 months of MP treatment. After 3 years of MP treatment, the height gain was 0.2 SDS (± 0.1 SD) lower in the SGA-GH/MP group (P = 0.17). Adult height was not significantly different between the SGA-GH/MP and SGA-GH group (-1.9 SDS and -1.9 SDS respectively, P = 0.46). Moreover, during the first 3 years of MP treatment IGF-I and IGFBP-3 measurements were similar in both groups.
Conclusion:
MP has some negative effect on growth during the first years in short SGA children treated with GH, but adult height is not affected.
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