Growth hormone deficiency: diagnosis and treatment

Growth hormone (GH) and thyroxine are the major growth promoting hormones in postnatal life. The pulsatile pattern of GH-release by the anterior pituitary is regulated by the interaction of stimulating and inhibiting hormones and influenced by physiological and pharmacological factors. GH promotes longitudinal bone growth mainly through activation of insulin-like growth factor I (IGF-I), but there may also be a direct effect. The most important clinical feature of growth hormone deficiency (GHD) is a low growth velocity resulting in short stature. In addition to retardation of bone maturation many GH-deficient children exhibit a number of typical, clinical characteristics. The diagnosis GHD can be confirmed by performing GH-stimulation tests and IGF-I measurements. However, the maximal GH-response to provocative stimuli is a poor indicator of the spontaneous GH-secretion. Classifications and etiology of GHD are given. Since 1958 GH-deficient children are treated with human GH with initially disappointing results regarding attained final height. Early diagnosis and treatment and optimization of GH-dose, mode of administration and injection frequency might improve final height. In The Netherlands the currently used GH-dose is 12-14 IU/m2/week in 6 or 7 daily doses administered subcutaneously. Ongoing retrospective and prospective studies serve to determine optimal treatment schedules. Up to now, important adverse effect of GH-therapy with the current GH-doses in GH-deficient children are not known. The beneficial effects of long-term GH-treatment of GHD adults is at present subject to ongoing investigation.(ABSTRACT TRUNCATED AT 250 WORDS)