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RARE ACQUIRED NEUROLOGICAL DISORDERS IN TWO PATIENTS ON LONG-TERM HUMAN GROWTH HORMONE (hGH) THERAPY

Acquired neurological disorders are not known to occur in association with either GH deficiency or hGH therapy. Two of our group of over 50 patients receiving hGH developed unusual and rare neurological disorders.A 13 year old boy treated for isolated GH deficiency from the age of 4 years developed the Guillain-Barré syndrome (GBS) while still on therapy, and required assisted ventilation. Recovery was prolonged but complete. A 17 year old boy with anterior hypopituitarism receiving thyroxine and cortisone and on hGH since the age of 4 developed dysphagia and dysarthria. Cranial nerves were affected and there was atrophy and fasciculation of the tongue. After extensive studies the diagnosis of bulbar amyotrophic lateral sclerosis (ALS) was made. The neurological deficit progressed and he required gastrostomy and assisted ventilation.Both GBS and ALS are rare diseases in children. The cause of neither is known. GBS may follow viral infections or injection of a foreign protein. A slow virus infection and autoimmunity have been postulated for ALS. The occurrence of these rare neurological disorders, possibly having similar etiologies, in two children treated with hGH for years may well be fortuitous. Nevertheless, since hGH is obtained from cadavers, one cannot dismiss the possibility of a causal association.