Growth hormone therapy in children with short stature

Growth hormone therapy in children with short stature – Tips from Other Journals

Richard Sadovsky

Therapeutic use of growth hormone has expanded to treatment in children with short stature that is not caused by growth hormone deficiency. Growth hormone therapy appears to improve the height velocity in many short children, at least in the initial stages of therapy, although it also accelerates bone maturation. This maturation may counteract the height improvements in some patients and may have an adverse effect on final height. Use of growth hormone in children with non-growth-hormone-deficient short stature is controversial. Kawai and associates conducted a retrospective controlled study to evaluate the influence of growth hormone therapy on bone maturation and final height in boys with non-growth-hormone-deficient short stature.

Twenty-seven boys with short stature were divided into a control group that did not receive any drugs that might affect growth or bone maturation and a treatment group that received pituitary-derived or recombinant human growth hormone in a dosage of 0.17 mg per kg per week administered five to six times weekly for 3.5 to 4.8 years. Final height was defined as the height when a previous year’s height gain was less than 1 cm.

Growth hormone therapy appeared to contribute to earlier onset of puberty by advancing bone maturation during the prepubertal period. The differences in pubertal height gain and final height between the two groups indicate that growth hormone therapy decreases final height by having a negative effect on pubertal height gain. The final height obtained by the treatment group was shorter than might have been attained without growth hormone therapy.

The authors conclude that growth hormone therapy during the prepubertal period did not improve height and actually resulted in shorter final height than what would have been attained naturally. This may be the result of accelerated bone maturation and reduction of the duration of puberty.

In an accompanying editorial, Rosenfeld discusses supporting evidence that growth hormone therapy in unselected “normal” short children is of limited value and may even compromise final height. He concludes that although some normal short children will achieve greater height with growth hormone therapy, short children with normal growth velocities may be negatively affected by the early and rapid pubertal progression caused by growth hormone therapy. Care must be used in selecting normal short children for growth hormone therapy.

Kawai M, et al. Unfavorable effects of growth hormone therapy on the final height of boys with short stature caused by growth hormone deficiency. J Pediatr 1997;130:205-9, and Rosenfeld RG. Is growth hormone just a tall story? [Editorial]. J Pediatr 1997;130:172-3.

COPYRIGHT 1997 American Academy of Family Physicians

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