Use of Growth Hormone in the Treatment of Short Stature: Boon or Abuse?
Paul Saenger MD1
1 Professor of Pediatrics, Division of Pediatric Endocrinology, Department of Pediatrics, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, New York 10467
Growth hormone (GH) was isolated approximately 30 years ago. Since then, we have witnessed major advances in understanding the regulation and pattern of GH secretion and its many metabolic actions.1
With the advent of recombinant DNA-generated growth hormone (rhGH) in 1985, the opportunities to treat children who have organic or idiopathic GH deficiencies are now, for the first time, unlimited.
DEFINITION OF GROWTH HORMONE DEFICIENCY
Although a role for GH in the treatment of certain children deficient in GH is established, the definition of GH deficiency remains controversial. The controversy surrounding the diagnosis of GH deficiency was highlighted recently when it was shown that, among the many commercial assay kits available, the same serum sample yielded GH concentrations that differed by as much as 100% for the same sample. Using different GH assay kits, a child who has short stature could be determined to be deficient in GH in the view of one endocrinologist but to have sufficient GH (ie, to be normal) by another endocrinologist.2,3
Despite these obvious limitations, GH testing has an important role in the clinical evaluation of the child who is short. When a child fails a simple screening test (ie, serum GH level of <10 ng/mL following vigorous exercise, such as running for 20 minutes), more definitive GH testing is the next step.
