Children can benefit from pituitary volume increase

Physicians have known that the pituitary gland plays a significant role in controlling human growth. When parents suspect their child might not be growing at a normal rate, they naturally can become concerned. It is then the role of the physician to determine whether there is an organic cause for the shorter stature and, if so, how to treat the child in hopes of promoting normal growth. But how can physicians ascertain what is considered ‘normal’ when it comes to height and stature as it relates to the function of the pituitary gland?


Growing up and coming of age is fraught with myriad challenges, from making friends and excelling in school to competing in sports and balancing academics with family life. Every child goes through phases of feeling insecure and intimidated. When it comes to the child who might be slightly or significantly shorter in stature than his or her peers, that insecurity can percolate into full-blown anxiety.

Physicians have known that the pituitary gland plays a significant role in controlling human growth. When parents suspect their child might not be growing at a normal rate, they naturally can become concerned. It is then the role of the physician to determine whether there is an organic cause for the shorter stature and, if so, how to treat the child in hopes of promoting normal growth. But how can physicians ascertain what is considered ‘normal’ when it comes to height and stature as it relates to the function of the pituitary gland?

Fortunately, there is a test that can give pediatric specialists an indication of whether the pituitary gland is functioning correctly and whether a child is at risk for impeded growth. The growth hormone stimulation test, which gauges pituitary volume in patients with isolated growth hormone deficiency, gives doctors an indication of whether a child is at risk for shorter-than-normal stature and should be treated hormonally. According to Richard Noto, MD, Chief of the Diabetes and Endocrine Center for Children and Young Adults at Boston Children’s Health Physicians, the test gives doctors considerable information regarding a patient’s growth status. Unfortunately, he points out, the benchmark is high in order for children to receive treatment; that is to say, children have to ‘fail’ each of a pair of tests to be eligible for growth hormone treatment, and then it is a question as to whether such treatment will be covered by insurance, or not.

“Most hormones are secreted is a ‘pulse’ manner,” Dr. Noto explains of the pituitary volume test, where doctors look for ‘peaks’ in testing results. “You have to catch one of those peaks of pulsatile secretions.” Children who undergo the tests are administered two different medications, with each considered a separate component of the procedure. “A child has to ‘fail’ both tests to be considered hormone deficient,” Dr. Noto says. Children who do not ‘pass’ the test are considered idiopathic short stature; the exact cause of the child’s short stature is unknown.

Herein lies the conundrum for parents, and for physicians who want to treat idiopathic short stature: insurance companies are loath to fund hormone treatment for idiopathic short stature — that is, children who ‘fail’ the benchmark tests. This leaves many children who might benefit from growth hormones out in the dark.

Short stature, Dr. Noto explains, can have deleterious effects on a child that can last into adulthood. Short stature can impact a child’s self esteem, self image, peer relationships, studies and extracurricular activities, and impact an adolescent’s relationships with the opposite sex as they approach adulthood.

“It really changes a person’s confidence,” Dr. Noto points out. He notes that many people feel that a person’s stature is merely a ‘cosmetic’ issue. “Half of my patients are on growth hormone,” he says. “Patients tell me, ‘You have no idea how it’s impacted my confidence.’ It can really be life-changing for a child. It’s a big deal.”

Dr. Noto cites a case of two brothers who both suffer from short stature, where one scores high on the benchmark test and is thus ineligible for treatment according to insurance company mandates. The other child, who scores poorly on both tests, is approved for treatment. The dichotomy can be emotionally painful for all concerned, Dr. Noto states. He views the system as patently unfair. “Insurance companies — all they want to do is spend as little money as possible. They make more money by providing less health care.”

Dr. Noto estimates that 22 percent of children considered idiopathic short stature are not being treated but should be: “They’re being denied treatment,” he says. “They say there is no problem. There is a problem!” Denying children the growth hormone that could have a real impact is unconscionable, Dr. Noto believes. He feels that politicians need to exert pressure over insurance company to put children’s lives and self-esteem above profits.