KIDS : DOCTORS MAY BE OVERPRESCRIBING GROWTH DRUGS.

Byline: Linda Carroll Medical Tribune News Service

Growth hormones - developed to help short children with hormonal deficiencies to grow normally - may be overprescribed, report Ohio researchers.

In a new study, many pediatricians said they would treat short children with growth hormones even in the absence of hormonal defects, said the researchers at Case Western Reserve University in Cleveland.

The investigators surveyed 434 pediatric endocrinologists who were asked their opinions and practices regarding growth hormones for children with no hormonal disorders.

They found that as many as 64 percent of these doctors would prescribe the growth stimulating hormones for especially short - but hormonally normal - children, according to the study, published Wednesday in the Journal of the American Medical Association.

More than 90 percent of the physicians in the study said they had used growth hormones to treat at least one ``normal,'' but short, child in the past five years, reported study author Dr. Leona Cuttler, a pediatrician at Rainbow Babies and Children's Hospital and Case Western Reserve University.

``Our results indicate that many pediatric endocrinologists consider growth-hormone treatment appropriate for selected short, non-growth-hormone-deficient children, going beyond current Food and Drug Administration-approved indications for growth hormone,'' Cuttler wrote.

A synthetic version of human growth hormone, known as recombinant human growth hormone, was approved in 1985 by the FDA solely for children with a classical deficiency in growth hormone.

Prescribing the hormones to increase height in children who do not have a deficiency of the hormone remains controversial. Existing studies have had conflicting results and do not conclusively prove that giving the hormone to such children will help, according to the National Institute of Child Health and Human Development in Bethesda, Md.

The few available studies have offered conflicting results as to whether additional growth hormone (GH) does anything more than speed growth in these children, according to Dr. Jennifer Bell, an associate professor of pediatrics at the Columbia Presbyterian Medical Center in New York City.

Even doctors in the survey had low expectations for the drug's efficacy. More than 75 percent of the surveyed physicians said that they expected no more than two inches of extra growth from GH-treated children.

Beyond this, GH treatment can have side effects, such as fluid retention in the brain - which can lead to very severe headaches and vomiting - and damage to cartilage-filled areas of growing hip bones

In addition, concerns have been raised that the hormones can cause leukemia, abnormal curvature of the spine, swelling, allergy and impaired glucose tolerance, a possible precursor to diabetes.

There is no real consensus about what to do with short children, Bell said. Part of the problem, she said, is that the tests for growth hormone deficiency (GHD) are not perfect.

Some children with normal blood levels of growth hormone just aren't growing at a normal rate, Bell said, while children who are genetically programmed to be short - but have no medical problems - will still grow at a regular rate.

Bell said she would not use GH treatments for children who are growing at a normal rate, but who will probably end up short.

Bell's response is not typical, according to the results of the survey.

Doctors who filled out the survey were presented with a series of hypothetical cases and asked whether they would prescribe growth hormone.

In one scenario, an exceptionally small child with short parents tests normal. More than half of the physicians surveyed said they would prescribe growth hormones to the child, the study found. An even larger group - over two-thirds - said they would prescribe the drug if the price went down from $13,000 to $100 per year.

The whole issue comes down to America's obsession with size, according to a pediatrician who wrote an editorial accompanying the article.

``Parental pressure to mitigate short stature in their children is driven by a cultural `heightism' that permeates American society,'' wrote Dr. Barry Bercu, of the division of pediatric endocrinology at the University of South Florida College of Medicine in St. Petersburg. ``Taller college graduates make more money, and 80 percent of U.S. presidents have been the taller candidate.''

Our society treasures height, Bell agreed. ``The beautiful people are the tall people,'' she added.

Parents are also worried that their children will be teased and emotionally harmed, Bercu noted.

But, there are no studies showing that short children suffer psychological trauma, Bell said.

``Children are often teased if they are too fat or too thin or if their noses are big,'' she added. ``It would be very hard to say that if a child had been taller, he might have escaped teasing.''