ESPE Abstracts

Introduction: Growth hormone therapy has been approved in the management of short stature secondary to various causes for many years. The safety of growth hormone therapy is questioned in different aspects, one of which is scoliosis development or progression.

Cases: We are reporting two cases addressing the concerns of scoliosis and growth hormone (GH) therapy.

First case: A 12 years old girl, presented initially at age of 8 years with concern of short stature. After full evaluation, patient found to be GH deficient and started on GH therapy with good response. The dose was increased up to 50 mcg/kg/day among follow up based on the clinical response. After two years of therapy; patient noted to have abnormal back exam in form of shoulder asymmetry and mild spine curvature. Radiological evaluation showed scoliosis with cobb’s angle of 31 degrees and concern of hemivertebrae or bars. Patient was referred to orthopedic team for evaluation, and decided for Bracing. Upon further follow up; patient showed improvement in cobb’s angle to 28 degrees with Boston brace being applied. Patient continued on GH until she reached acceptable final adult height.

Second case: A 6 years old girl; known case of congenital neutropenia, congenital scoliosis and short stature with z score of -3.66. Her neonatal history was significant for being small for gestational age, with birth weight of 1.9 kg. After discussion with the family and the orthopedic team, it was decided not to start the patient on GH; as she is having progressive scoliosis with cobb’s angle of 40 degrees.

Discussion: The role of growth hormone therapy in development of scoliosis remains debatable.¹ Scoliosis is a three-dimensional spine deformity. It is classified as congenital, neuromuscular, syndrome‐associated, and idiopathic scoliosis, of which adolescent idiopathic scoliosis (AIS) is the most common.² The etiology is multifactorial, with different contributors including genetic, biomechanical, hormonal and environmental factors. The role of growth hormone in the development or progression of scoliosis is observed during the period of rapid growth velocity in puberty and the progression of scoliosis in adolescence.³ Multiple studies looked into the risk of GH therapy to develop scoliosis with inconsistent results.⁴

Conclusion: The risk of adolescent idiopathic scoliosis must be considered in all patient planned to be treated with GH therapy. For early detection and intervention, periodic clinical assessment must be done before starting and during follow up visits in patients receiving GH therapy.