Growth hormone deficiency is rare in short children with attention-deficit hyperactivity disorder taking psychostimulants-a reevaluation of GH testing in this diagnostic group

Abstract

Introduction: Attention deficit hyperactivity disorder (ADHD) is one of the most common psychiatric/behavioural disorders in childhood. Children with ADHD on psychostimulants may exhibit poor growth necessitating a paediatric endocrine referral to exclude growth hormone deficiency and other causes of poor growth. Aim: To determine if there are any distinct clinical or biochemical parameters in children with ADHD on psychostimulants compared with children with Idiopathic short stature (ISS) who were referred for GH provocation testing. Methods: As part of a retrospective chart review of all children who underwent GH provocative testing (combined arginine-glucagon) between 1998 and 2013, we identified 51 subjects with ADHD who were taking pyschostimulants. Data collected included age, sex, height, weight, body mass index (BMI), pubertal staging, ESPE diagnosis code, GH provocation test results, thyroid function tests, serum IGF-1 and IGF-BP3 levels. Results: The total group with non-GHD short stature included 428 subjects: 283 males (66%) and 146 females (34%). In the ADHD group (n = 51), 45 were males (88.2%) and 6 were females (11.8%). There was statistically significant difference in the gender among the groups (Chi square degrees of freedom one = 13.31; p = 0.00). There was no significant difference in stage of puberty between the two groups with 68.6% prepubertal in the ADHD group compared to 75.6% in non-ADHD group (χ2 df (3) = 2.808; p = 0.422). All the subjects in the ADHD group had a normal serum IGFBP3 level while 20 out of 51 patients in ADHD group had a low serum IGF-1. Summary and conclusion: There was a significant difference in age and gender between subjects within the ADHD and the non- ADHD groups. GHD in children with poor growth associated with ADHD and psychostimulant medication is rare. This suggests GH testing in short children with ADHD is generally unnecessary and perhaps serum IGFBP3 rather than IGF-1 may be used as a surrogate marker of GH sufficiency.L720733792015-11-20 <br />