For stimulation of growth velocity in children with growth hormone (GH) deficiency the ideal GH dose should result in catch-up growth, provide realization of adult height potential, allow puberty to occur at a normal time, and avoid adverse events. During the years 1958ndash;1985, the standard replacement dose for GH deficiency was limited by GH supply. After the introduction of recombinant GH, the mean dose increased from 0.1 to 0.3 mg/kg/week, which appears to be about three times the normal GH production rate. First year growth velocity response to GH replacement in GH deficiency is positively correlated to the logarithm of the GH dose. Slightly higher doses are commonly used in the treatment of other causes of growth failure such as Turner's syndrome and chronic renal insufficiency (currently 0.375 and 0.35 mg/kg, respectively), although there have been no studies to establish that these doses are ideal.Certain adverse events, particularly those that are related to fluid retention, appear to be dose-dependent. These events occur infrequently in children but are quite common in adults. To avoid adverse events, the doses for GH replacement in adults (0.5ndash;1.5 mg/day) must be considerably lower, when calculated on a weight basis, than those used in children. The ideal GH dose varies according to diagnosis and age and should be tailored to the individual situation.
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