Are We Overtreating Children with Growth Hormonequest;

摘要

Until recently, shortness of stature was viewed merely as an individual attribute, with no ldquo;therapyrdquo; available or imagined. In this article, historical perspective is provided for diagnosis of conditions causing short stature, development of methods for diagnosis of insufficient growth hormone secretion, controversies in diagnosis, and trends in growth hormone therapy. A decision tree is offered for current evaluation of short children for possible classic or subtle disorders of growth hormone release. Guidelines for administration of growth hormone, for choices about who should be treated versus who should be studied, and benefits and risks of growth hormone therapy are discussed. Participation of very short but non-growth hormone-deficient children in controlled trials may finally resolve the questions of whether growth hormone therapy alters final adult height or adult psychosocial adjustment and may help to evaluate the benefit-risk balance of such treatment. Pragmatic use of growth hormone in short normal children outside of controlled trials is not currently appropriate.