Case Reports Growth Attenuation Found in Four Pediatric Pati

Case Reports Growth Attenuation Found in Four Pediatric Patients on SSRIs
http://www.medscape.com/viewarticle/442653_1
Brown University Child and Adolescent Psychopharmacology Update 4(10):1,2-4, 2002.
© 2002 Manisses Communications Group, Inc.
Posted 10/30/2002

Introduction

A new report of four cases suggests there may be an isolated effect of selective serotonin reuptake inhibitor (SSRI) therapy on growth and possibly growth hormone secretion in some children who are taking these medications, providing new and controversial evidence of a possible association between treatment with SSRIs and endocrinologic adverse events. Studies linking SSRIs with endocrinologic changes have been previously reported in the adult literature.[1] However, no information exists on the effects of therapy on growth and puberty in pediatric populations, as the focus of the investigations conducted in children and adolescents have been primarily psychiatric rather than endocrinologic. This is the first report in children to suggest that there might be an isolated effect of SSRI therapy on growth and possibly growth hormone (GH) secretion, which the authors speculate could possibly “via a reduction of central alpha2-adrenoreptor-mediated GH release.”[2] However, experts say that the findings remain preliminary and caution against making any conclusions about the effects on growth due to therapeutic use of SSRIs in this population at this time.

Case Study

Naomi Weintrob, M.D., of the Institute for Endocrinology and Diabetes at Schneider Children’s Medical Center of Israel, and colleagues report on four pediatric patients who showed growth attenuation and decreased growth hormone (GH) secretion during treatment with SSRIs for obsessive-compulsive-disorder or Tourette syndrome. All patients were treated with either fluvoxamine (dose range, 50 to 100 mg per day) or fluoxetine (dose range, 20 to 80 mg per day) for a period of six months to five years and showed growth attenuation or arrest despite the absence of chronic disease and other hypothalamic-pituitary function abnormalities. Patients (3 boys, 1 girl) in the study were referred to an endocrinologic clinic for short stature, slow growth rate and/or overweight. Three patients had decreased GH response to clonidine stimulation and two patients to both clonidine and glucagon stimulation. In each of the patients, weight gain was consistent during SSRI therapy, and thyroid, prolactin and urinary cortisol levels appeared within normal range.

Case Report One

In the first case, an 11-year-old girl with Tourette syndrome began treatment with fluvoxamine 50 mg a day. After six months of SSRI therapy, she showed growth arrest despite normal pubertal development, consistent weight gain, and normal prolactin levels and other anterior pituitary functions. Usual growth resumed after fluvoxamine was discontinued at 12years, 1 month.

Case Report Two

In the second case, a 13-year-old boy with obsessive-compulsive disorder was treated with fluoxetine 80 mg a day. After six months of treatment, he showed growth attenuation, followed by complete growth arrest for four months. Weight gain was consistent during SSRI therapy and thyroid, prolactin and urinary cortisol levels appeared normal. Treatment with fluoxetine was discontinued. Growth velocity improved, and an increase intesticular volume was noted, indicating progression of puberty. Fluoxetine therapy was resumed at 15 years, 11 months, but discontinued again after six months of treatment due to a recurrent decrease in growth velocity. Usual growth resumed after discontinuation of SSRI therapy.

Case Report Three

The third case involves a 12-year old boy who had received methylphenidate from age 5 to 10 years and had been switched to risperidone1.0 to 1.5 mg a day and fluvoxamine 100 mg a day for Tourette syndrome andADHD. Growth attenuation was noted from age 6 to 11 years. A one-year follow-up revealed a decrease in growth velocity, but with consistent weight gain and pubertal progression. SSRI therapy in this patient could not be discontinued. Therefore, somatropin therapy was started when the boy was14.5 years, resulting in a marked improvement in growth.

Case Report Four

In the final case, a 12-year-old boy who had been receiving methylphenidate 10 mg a day for ADHD since he was seven years old was started on additional therapy with fluvoxamine 150 mg a day for obsessive-compulsive disorder. The fluvoxamine was later switched to fluoxetine 20 mg a day. The boy’s growth rate slowed, and his height dropped from the 50th percentile to the 15th percentile within one year. Weight gain was consistent and thyroid, prolactin and urinary cortisol levels appeared normal. Somatropin therapy was started when the boy was 14 years old as treatment with fluoxetine could not be stopped due to his psychiatric symptoms. After the addition of somatropin, there was an increase in growth rate and pubertal advancement.

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