Scoliosis in Patients Treated with Growth Hormone

Two hundred fifty children being treated with growth hormone were screened for scoliosis by using the Adams and Bunnell techniques. If indicated, an anteroposterior radiograph was done and measured by the Cobb and Risser methods. Scoliosis was defined as a frontal curve of > or = 10 degrees; progression, as a sustained increase of > or = 5 degrees, and a progressive curve as one > or = 25 degrees and meeting our criteria for orthotic management. In 10 of the 250 patients, scoliosis developed. Six curves were double major thoracic and lumbar; three thoraco-lumbar; and one single thoracic. Six of the 10 patients had progressive curves and required an orthosis. Their average annualized rate of progression was 26 degrees. Progression was associated with double major curves and an earlier Risser stage. Despite bracing, progression continued to fusion in three patients. We conclude that growth hormone may increase the risk of progression of scoliosis. Furthermore, the progression is frequently rapid and requires special vigilance by the treating physician.