Recognition of Growth Hormone Secretory Disorders

Abstract

The demonstration by Raben¹that only growth hormone (GH) extracted from human or primate pituitaries could stimulate growth in pituitary dwarfs was a milestone in clinical endocrinology. Because the supply of GH from human pituitaries was limited, endocrinologists concentrated on determining who was "truly" GH deficient by measuring serum GH levels after the induction of hypoglycemia or the administration of arginine, levodopa, clonidine, and other potent GH secretogogues. Rises in serum GH levels to more than 7 to 10 ng/mL were considered "normal." Because a minority of apparently normal children might fail to respond to any one stimuli, the National Pituitary Program required failure to respond to two appropriate stimuli to qualify for GH treatment. The prospect of the more general availability of bacterially synthesized methionyl GH has led to a reexamination of GH secretion in short children. There is legitimate concern that GH response to potent pharmacologic stimuli