How JustAnswer Works:

  • Ask an Expert
    Experts are full of valuable knowledge and are ready to help with any question. Credentials confirmed by a Fortune 500 verification firm.
  • Get a Professional Answer
    Via email, text message, or notification as you wait on our site.
    Ask follow up questions if you need to.
  • 100% Satisfaction Guarantee
    Rate the answer you receive.

Ask beandoctor Your Own Question

beandoctor
beandoctor, Pediatrician
Category: Pediatrics
Satisfied Customers: 334
Experience:  Board Certified; Graduated from top 20 medical school
62306205
Type Your Pediatrics Question Here...
beandoctor is online now
A new question is answered every 9 seconds

10.10 year old son starting puberty but only in 15 perc for

Resolved Question:

10.10 year old son starting puberty but only in 15 perc for height. Bone scan went from 8 yrs old to 11 year old in 11 months. Las Vegas ped endo won't prescribe lupron or growth hormone. Says he will be 5'5 or at best 5'6. Can you tell me a ped somewhere near las Vegas that will help.
Submitted: 2 years ago.
Category: Pediatrics
Expert:  beandoctor replied 2 years ago.

I'd love to try to help with your question... but unfortunately, there may not be an easy solution to this.

 

First, it sounds like your son's diagnosis is idiopathic short stature - is that what you've been told? Essentially, that just means that a person is short without a medical reason (like kidney disease or a hormone deficiency). Usually, kids with idiopathic short stature are shorter children because their parents are shorter adults - so it's sort of "in the cards" for them, genetically speaking.

 

For children with severe idiopathic short stature, many endocrinologists will prescribe recombinant human growth hormone injections, as you suggest.

 

These injections, though, have a downside. For one, although they're effective, they're only modestly effective for children with idiopathic short stature (compared to children with growth hormone deficiency, for example). Basically, at your son's age, you could probably hope for an improvement of only a few inches versus his height without growth hormone. Another disadvantage is that the medication must be administered as a daily injection. I emphasize daily, because if you only give the medication a few days a week, the body tends to not make growth hormone on the days you don't give it - so to attain a real improvement in height takes giving the medication every single day for a sustained period of time. The injections are not especially painful, but the fact that the medication must be administered as a "shot" can be a significant hurdle for some children and families. And finally, the medication is expensive.

 

Generally speaking, insurance companies will only cover growth hormone for children with idiopathic short stature whose height percentiles are much lower than your son's - usually less than 3rd percentile. That means that you'll end up having to pay for the medication out-of-pocket...

 

To give you an idea about how expensive that might be, I just looked up the cost of Genotropin. A 5 mg cartrige for injection costs $381.99... and I would ballpark that your son would need at least one of those every 4-5 days. There are other brands on the market, so you may be able to get the medication more cheaply... but I bring it up for the sake of example to give you a sense of just how expensive it might be unless your insurance covers it.

 

If the cost is not a concern for your family, then I think the best advice I can give you would be to obtain a second opinion from another pediatric endocrinologist. Unfortunately, I practice on the East Coast, so I can't recommend particular physicians - but your best bet would be to look at any children's hospitals or medical schools in your area (or surrounding areas). Another endocrinologist may be willing to prescribe the medication after discussing the risks and benefits with you.

 

I know this was not the answer that you were hoping to hear, but I hope that this information is helpful to you and helps to put this issue into perspective.

 

Best wishes to you and your son...

Customer: replied 2 years ago.
What about the possibility of delaying puberty? I know that this is done for children with rapid bone maturation due to puberty to give them more time to grow. Why would this not be an option based on the very low risk? And last, what about hgh releasers, or l larginine, are these safe options to help him in any way?
Expert:  beandoctor replied 2 years ago.

You are asking excellent questions!

 

There actually have been a couple of studies that looked at delaying puberty with medications like Lupron for children without precocious puberty (which is obviously the typical reason we would use medications to delay puberty). The results were somewhat mixed.

 

In children who were also treated with growth hormone, the results were good - an extra 8-14 cm of height (3-5 inches) were obtained, though puberty had to be delayed for at least 2 years. Unfortunately, for children with normally-timed puberty who did not also get growth hormone, the results weren't so good. Because of that, in 2009 the American Academy of Pediatrics did not include poor growth as a reason for prescribing Lupron in its most recent consensus statement.

 

In real life, I think that means two things. First, you almost certainly won't be able to get insurance to cover Lupron without a diagnosis of precocious puberty. And although Lupron is much cheaper than growth hormone, it's still expensive - the generic is around $350/month. Second, I think you'll be less likely to find a physician to prescribe Lupron than you would growth hormone, since the benefits are less clear.

 

Personally, I don't think I would prescribe Lupron in your son's case, for two reasons. The first one is that it's not clear how well it works unless you use growth hormone at the same time. The second one is that I'm not sure I entirely agree with you that delaying puberty is "very low risk." I say that because the risk of using medications to delay puberty could be adverse social consequences for your son. It's bad enough being the short kid - but it might be even worse to be the even shorter, pre-pubertal kid for the next several years. (For this reason, most endocrinologists stop Lupron by 12 years old for boys with precocious puberty.)

 

L-arginine could be helpful - but there really aren't any real clinical studies on using that for the situation your son is in. (The only articles I could find were negative ones, suggesting that oral supplementation with arginine does not cause a sustained increase in the level of growth hormone.) I don't think there is much downside - other than cost - to trying that, though.

 

Again, I know that this information is probably not what you were hoping to hear - but it's my honest opinion, and what I would say if one of my own family members were asking me the excellent questions that you are.

 

If I have answered your question, please click accept - and if you have any additional questions about any of this (or anything else in the future) please do not hesitate to ask.

Customer: replied 2 years ago.
I must say, although I was hoping for different answers, you have been fabulous. I have one final question and then I will let you move on and pay whatever I need to pay for your expertise.

If it were your son and you could give him 2 or 3 inches by buying the growing hormone (with the expected height of 5'5) which could mean the difference of being able to follow his dream of an MLB player and a more normal life, would you do so? There are no players in the MLB under 5'8.

I feel as if the cut off age of 5'4 for growth hormone, per much research,for boys and his expected height of 5'5 is truly a shame. If he is not reaching his mid parental height then there is some issue whether it be small or not. Why would I not give him every opportunity to reach his potential, even if I must do it on my own.

I have researched jintropin. Thank you and I look forward to your final thoughts. Pamela
Expert:  beandoctor replied 2 years ago.
Pamela, your questions get harder and harder! The sports issue does change things a bit, doesn't it?

I have a son of my own, actually. He's not quite 3, though, so he's not yet dreaming of playing in the MLB. But I thought about your question for a while, and this is what I think you should do.

1) I think you should get a second opinion from a new pediatric endocrinologist. The purpose of this will be twofold. The first thing will be to make sure that there isn't something that we've missed along the way that would explain your son's poor growth. As you suggested, it is a bit unusual for him to fall so far below what should be his genetic height potential... and if there is something that we're missing, now is the time to find it. The second reason will be so that you can find someone with whom you can have a frank conversation about starting growth hormone. (You mentioned that your son's endocrinologist was unwilling to prescribe it... and if you're unable to find an endocrinologist who will, the rest of this sort of becomes moot.)

2) Assuming that you find a doctor with whom you see eye-to-eye and his/her evaluation does not turn up anything else that we could work on to improve your son's growth, the next step is to get some real numbers to inform your decision-making. I looked up the cost of Genotropin just to give you a ballpark idea of what the cost might be... but there are half a dozen manufacturers of growth hormone at this point, and you may be able to find one at a lower cost where you live. (I just looked up Nutropin, for example, and it looked to be around $100 cheaper for the same dose compared to Genotropin.) Additionally, because the pharmaceutical companies want you to use their brand, most of them offer some kind of rebate program or coupon for people who have to pay out of pocket. There's a chance that something like that might be the difference between the medicine being affordable versus being out of the question.

The botXXXXX XXXXXne is, I think you'll have to have some real numbers to try to make this decision. If doing the growth hormone for a couple of years wouldn't be an unbearable hardship for your family, you may want to go for it. If it would mean forgoing every luxury, then obviously it's probably not the best idea. (Baseball camps and good coaches are also expensive, you know... and it's wise to save for his college education in case he doesn't get drafted or get a scholarship!) But once you have some real numbers, you can sit down and figure out how realistic committing to growth hormone for a couple of years might be. Without knowing that data and what the botXXXXX XXXXXne will be for your family, it's impossible to make that call.

If I can help with anything more as you work through all this, please let me know - and all my best to you and your son...

beandoctor, Pediatrician
Category: Pediatrics
Satisfied Customers: 334
Experience: Board Certified; Graduated from top 20 medical school
beandoctor and other Pediatrics Specialists are ready to help you

JustAnswer in the News:

 
 
 
Ask-a-doc Web sites: If you've got a quick question, you can try to get an answer from sites that say they have various specialists on hand to give quick answers... Justanswer.com.
JustAnswer.com...has seen a spike since October in legal questions from readers about layoffs, unemployment and severance.
Web sites like justanswer.com/legal
...leave nothing to chance.
Traffic on JustAnswer rose 14 percent...and had nearly 400,000 page views in 30 days...inquiries related to stress, high blood pressure, drinking and heart pain jumped 33 percent.
Tory Johnson, GMA Workplace Contributor, discusses work-from-home jobs, such as JustAnswer in which verified Experts answer people’s questions.
I will tell you that...the things you have to go through to be an Expert are quite rigorous.
 
 
 

What Customers are Saying:

 
 
 
  • I feel so much better today, and upon further investigation believe that there is a chance that the responses I got saved me from a serious, even life threatening situation. I am very grateful to the experts who answered me. Susan O. USA
< Last | Next >
  • I feel so much better today, and upon further investigation believe that there is a chance that the responses I got saved me from a serious, even life threatening situation. I am very grateful to the experts who answered me. Susan O. USA
  • I can go as far as to say it could have resulted in saving my sons life and our entire family now knows what bipolar is and how to assist and understand my most wonderful son, brother and friend to all who loves him dearly. Thank you very much Corrie Moll Pretoria, South Africa
  • I thank-you so much! It really helped to have this information and confirmation. We will watch her carefully and get her in for the examination and US right away if things do not improve. God bless you as well! Claudia Albuquerque, NM
  • Outstanding response time less than 6 minutes. Answered the question professionally and with a great deal of compassion. Kevin Beaverton, OR
  • Suggested diagnosis was what I hoped and will take this info to my doctor's appointment next week.
    I feel better already! Thank you.
    Elanor Tracy, CA
  • Thank you to the Physician who answered my question today. The answer was far more informative than what I got from the Physicians I saw in person for my problem. Julie Lockesburg, AR
  • You have been more help than you know. I seriously don't know what my sisters situation would be today if you had not gone above and beyond just answering my questions. John and Stefanie Tucson, AZ
 
 
 

Meet The Experts:

 
 
 
  • Dr. Yogindra Vasavada

    Pediatrician

    Satisfied Customers:

    2507
    M.D.(ped) passed at first attempt, in practice continuously for last 37 years. Certi. in Comp
< Last | Next >
  • http://ww2.justanswer.com/uploads/DR/Dr. Yogindra Va/2012-6-10_2618_DSC0039.64x64.JPG Dr. Yogindra Vasavada's Avatar

    Dr. Yogindra Vasavada

    Pediatrician

    Satisfied Customers:

    2507
    M.D.(ped) passed at first attempt, in practice continuously for last 37 years. Certi. in Comp
  • http://ww2.justanswer.com/uploads/GA/GauravMD/2012-6-9_62959_gaurav.64x64.JPG Dr. Gupta's Avatar

    Dr. Gupta

    Pediatrician

    Satisfied Customers:

    1442
    MD, practicing Pediatrician with 19 years of experience. Member American Academy of Pediatrics.
  • http://ww2.justanswer.com/uploads/edkulich/2010-08-17_171809_doctor.jpg Dr. K.'s Avatar

    Dr. K.

    Board Certified Pediatrician

    Satisfied Customers:

    819
    Board Certified, Ivy League educated Pediatrician.
  • http://ww2.justanswer.com/uploads/cbellmd/2009-11-19_013247_CB_PHOTO_2.jpg Raymond B., M.D.'s Avatar

    Raymond B., M.D.

    Doctor

    Satisfied Customers:

    422
    I provide medical care for newborns, children, adolescents and young adults up to age 21 years.
  • http://ww2.justanswer.com/uploads/DA/davhill1/2012-6-6_17340_DLHSittingCropped.64x64.jpg David L. Hill, MD, FAAP's Avatar

    David L. Hill, MD, FAAP

    Doctor

    Satisfied Customers:

    414
    Adjunct Assistant Professor of Pediatrics, UNC Medical School. Vice President, Cape Fear Pediatrics.
  • http://ww2.justanswer.com/uploads/josho33/2009-12-16_0435_php4n8fiy_c2PM.jpg Dr. Davidson's Avatar

    Dr. Davidson

    Board Certified Pediatrician

    Satisfied Customers:

    408
    Board Certified Specialist in Pediatrics, Allergy, Asthma & Immunology
  • http://ww2.justanswer.com/uploads/FA/fabiola.caracseghi/2012-4-12_204829_foto2.64x64.JPG Dr.Fabiola.MD's Avatar

    Dr.Fabiola.MD

    Pediatrician

    Satisfied Customers:

    118
    Pediatric Immunology. General Pediatrics
 
 
 
Chat Now With A Pediatrician
beandoctor
beandoctor
252 Satisfied Customers
Board Certified; Graduated from top 20 medical school