Deterioration of visual acuity associated with growth hormone therapy in a child with extreme short stature and high hypermetropia.
BACKGROUND
Growth hormone (GH) has long been implicated in the pathogenesis of diabetic retinopathy, although its precise role remains ill-defined. In 1998, an association between exogenous human GH and retinal pathology in non-diabetic subjects was described.


METHODS
A female child with extreme short stature of unknown aetiology (height -7.38 SD at 11.3 years) and severe hypermetropia developed retinopathy with visual deterioration during two separate empiric trials of GH therapy. On the first occasion, a relatively high dose of GH (10.5 mg/m2/week) administered from age 4.4 to age 4.7 years was associated with the development of central serous retinopathy, resulting in marked reduction in visual acuity. On cessation of GH, the macular oedema resolved, and visual acuity improved. At age 5.6 years, GH therapy was re-introduced at a lower dose (3.9 mg/m2/week) and her vision monitored closely. Bilateral retinal oedema recurred after 3 months, and GH therapy was stopped. Once again, the macular oedema regressed, and visual acuity improved following withdrawal of GH. These ophthalmic changes contra-indicated further GH therapy.


CONCLUSIONS
We suggest that GH may be a risk factor in the development of retinopathy in certain non-diabetic patients, especially in the presence of a severe refractive error.
Paterson
Wendy F
WF
Department of Child Health, Royal Hospital for Sick Children, Glasgow, UK. gcl354@clinmed.gla.ac.uk
Kelly
Brian
B
Newman
William
W
Savage
Martin O
MO
Camacho-Hubner
Cecilia
C
Dutton
Gordon N
GN
Tolmie
John
J
Donaldson
Malcolm D C
MD
D002648:Child; D002675:Child, Preschool; D005260:Female; D006130:Growth Disorders / Q000188:drug therapy*; D019382:Human Growth Hormone / Q000008:administration & dosage / Q000009:adverse effects*; D006801:Humans; D006956:Hyperopia / Q000150:complications*; D007223:Infant; D010211:Papilledema / Q000139:chemically induced*; D011994:Recombinant Proteins / Q000008:administration & dosage / Q000009:adverse effects; D014792:Visual Acuity / Q000187:drug effects*
D011994:Recombinant Proteins; D019382:Human Growth Hormone