Endocrine Abstracts

JOINT4031

Introduction: ☆ In children with profound mental disability, the normal linear growth and pubertal maturation can affect their life and their caregivers’ life in a negative way especially with limited mobilization and increased body size. ☆ The three most prevalent disabilities in Saudi Arabia are: motor disability at a rate of (1.0%), followed by visual impairment and communication disability at a rate of 0.6% each. ☆ There is limited data on the use of high dose estrogen dose to close the growth plates earlier and cause growth suppression.

Case: ☆ 10 years old boy, diagnosed with Spastic paraplegia type 86 based on genetic test. Which is an autosomal recessive complex neurological disorder, expressed by early childhood developmental delay, progressive spasticity that mainly affect the lower limbs, with inability to walk and cause intellectual developmental impairment. ☆ Currently; he speaks 10 to 15 words, can sit, crawl and stand, but cannot walk. He was referred to endocrine service with growth failure, went under growth hormone stimulation test, which was indicate growth hormone deficiency based on peak of GH 0.9. ☆ We counseled the family to start a high dose of growth hormone for growth and metabolic effect or use a low dose of growth hormone for metabolic impact only, and they elected to choose the high dose GH therapy.

Discussion: • Growth suppression in children with profound cognitive and physical disabilities consider ethically questionable. It can be viewed from several perspectives:

1- Construct Argument:

•Beneficences:

• Direct benefit to the patients and their families by improving quality of life (mobilization, decreasing bed sores, and risk of obesity).

• -Indirect benefit to the society

• Justice:

-No research in this field is Not harmful but avert benefice.

-No research in this field Augment vulnerability.

2- Counter Argument:

• Consent and conflict of interest

Estrogen therapy for growth suppression is a research medication and consent by third party (not by family) is indicated.

• Harm.

• Social Injustice.

Conclusion: ☆ Growth attenuation offers the possibility of an improved quality of life for children with profound cognitive disability. ☆ It can be achieved naturally by allowing precocious puberty to run its course or by treating GH deficiency with metabolic dose (Passive suppression). ☆ Estrogen therapy is ethically questionable