4 Therapy of growth hormone deficiency

Abstract

Treatment with human growth hormone in growth hormone deficient patients will improve growth rate significantly, initially demonstrating catch-up growth and later bringing forth a normal growth rate. During childhood, a dose of 0.3-0.6 units/kg body weight per week (or 14 units/m2 body surface area per week) is recommended, but during puberty the dose should be increased by 50-100%. The goal of therapy is the attainment of a normal final height, which in the past has often not been fulfilled. This was partly due to the inadequate supply of growth hormone. Since recombinant human growth hormone is now available in unlimited amounts, all patients can be treated continuously. The shorter the child is at time of presenting for therapy, the lower final height will be. It is mandatory to start therapy as early as possible. Concomitant hormonal deficiencies must be corrected by adequate therapy. Despite the fact that growth hormone is diabetogenic, supplementary therapy will not induce diabetes mellitus. Subtle changes in the immune system can be detected but no clinical correlates, such as increased susceptibility to infection, exist. Induction of leukaemia has been suspected as a possible side-effect of human growth hormone treatment but so far there is insufficient evidence to prove that growth hormone is oncogenic.