Slow growth and short stature in children with attention deficit hyperactivity disorder (ADHD): a retrospective study of 493 children who underwent growth hormone provocation testing at one tertiary paediatric endocrine centre

Vallimayil Velayutham; Suparna Chakrabarty; Ristan Greer; Andrew M. Cotterill; Gary M. Leong

doi:10.1515/jpem-2024-0268

Article

Slow growth and short stature in children with attention deficit hyperactivity disorder (ADHD): a retrospective study of 493 children who underwent growth hormone provocation testing at one tertiary paediatric endocrine centre

Vallimayil Velayutham , Suparna Chakrabarty , Ristan Greer , Andrew M. Cotterill and Gary M. Leong

Published/Copyright: September 17, 2024

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From the journal Journal of Pediatric Endocrinology and Metabolism Volume 37 Issue 11

Abstract

Objectives

We hypothesised that growth hormone (GH) deficiency (GHD) in children with attention deficit hyperactivity disorder (ADHD) is rare. This study aimed to determine any distinct clinical or biochemical parameters, including GH provocation testing, in children with ADHD on psychostimulants or idiopathic short stature (ISS).

Methods

Retrospective cross-sectional study of children who had GH provocative testing between 1998 and 2013 at one tertiary paediatric endocrine centre. Clinical data included age, sex, anthropometry, pubertal staging, bone age, diagnostic code as per the European Society Paediatric Endocrinology (ESPE), GH provocation test results, thyroid function tests, serum insulin-like growth factor-1 (IGF-1) and insulin-like growth factor-binding protein-3 (IGFBP-3) levels.

Results

Four hundred ninety-three subjects underwent GH provocation testing for investigation of short stature to exclude GHD during the study period. Fifty-one children had a diagnosis of ADHD. In the remaining children, the diagnosis was Idiopathic short stature (n=240), GHD +/− hypopituitarism (n=60), and 142 subjects had other causes of short stature. Children with ADHD were older, had higher height and weight SDS and were GH-sufficient. All 51 children with ADHD had a normal serum IGFBP-3, while 20 out of these 51 subjects had a low serum IGF-1.

Conclusions

GHD in children with ADHD on psychostimulant medication is rare. GH testing in children with ADHD may not be necessary, particularly if serum IGFBP-3 is in the normal range. We suggest IGFBP-3 could be used as a surrogate marker of GH sufficiency in children with ADHD. However, this needs to be confirmed with a larger study group.

Keywords: short stature; poor growth; ADHD; growth hormone deficiency; IGF 1; IGFBP-3

Corresponding author: Associate Professor Gary M. Leong, Department of Paediatric Endocrinology and Diabetes, Mater Children’s Hospital and Queensland Children’s Hospital, South Brisbane, QLD, Australia; and Department of Paediatrics, Nepean Hospital, Kingswood, and the Nepean Charles Perkins Centre Research Hub, Nepean Clinical School the University of Sydney, NSW, Australia, E-mail: gary.leong@health.nsw.gov.au

Current address: Vallimayil Velayutham, Institute of Endocrinology and Diabetes, The Children’s Hospital Westmead, NSW, Australia, E-mail: vallimayil.velayutham@health.nsw.gov.au. Current address: Suparna Chakrabarty, Townsville Hospital and James Cook University, Townsville, QLD, Australia, E-mail: suparna.chakrabarty@health.qld.gov.au. Current address: Ristan M. Greer, PhD MANZCVSC (epidemiology) BA BVSc MVSc, Mater Research Institute-UQ, Faculty of Medicine, Brisbane, Australia, Torus Research Brisbane, Australia, E-mail: rmg@torusresearch.com.au. Current address: Andrew M. Cotterill, Department of Paediatric Endocrinology and Diabetes, Queensland Children’s Hospital, South Brisbane, QLD, Australia, E-mail: andrew.cotterill@health.qld.gov.au.

Acknowledgments

The authors would like to thank A/Prof Tony Hyunh and Dr Mark Harris for reviewing the manuscript, endocrine nurse Sinead Archibald from Mater Children’s Hospital for caring for patients during GH testing, and the participants and their families who participated in this study.

Research ethics: Ethics approval was obtained from the Mater Health Services Human Research Ethics Committee.
Informed consent: Not applicable.
Author contributions: The authors have accepted responsibility for the entire content of this manuscript and approved its submission.
Competing interests: The authors declare that there is no conflict of interest associated with this manuscript.
Research funding: None declared.
Data availability: The raw data can be obtained on request from the corresponding author.

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Received: 2024-06-02

Accepted: 2024-08-26

Published Online: 2024-09-17

Published in Print: 2024-11-26

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Articles in the same Issue

https://doi.org/10.1515/jpem-2024-0268

Keywords for this article

short stature; poor growth; ADHD; growth hormone deficiency; IGF 1; IGFBP-3