Growth hormone therapy for the growth-hormone deficient child

In the five decades in which growth hormone has been prescribed for children with growth hormone deficiency (GHD) there has been definite progress, but on the other hand there is still insufficient evidence to answer many basic questions. From an evidence-based perspective the present situation with respect to growth hormone treatment for GHD is therefore far from optimal. First, the diagnosis GHD cannot be defined precisely, because there is a wide range of growth hormone secretion in normally growing individuals, which overlaps with the range observed in children clinically suspected of GHD. Furthermore, all test parameters available have serious drawbacks (1). Therefore, the term GHD stands for a heterogeneous group of congenital or acquired deficiencies (or apparent deficiency). Most patients have an idiopathic isolated GHD, but particularly in that subgroup retesting at the end of growth often shows a normal stimulated growth hormone peak. Of the acquired (organic) GHD, malignancies are the most frequent aetiology, but the incidence of traumatic brain injury may be underestimated.