Start treatment early and give it for long enough

Papers p 70

With the advent of an unlimited supply of recombinant DNA growth hormonesome 15 years ago endocrinologists and paediatricians hoped that the majorgoal in treating children with growth hormone deficiency—that is, a near normal adult height—would finally be achievable.

Carel and colleagues report in this issue the adult height after “long term” recombinant growth hormone treatment for idiopathic isolated growth hormone deficiency.1 The investigators were able to analyse entry data on all French children with growth hormone deficiency whose treatment started between 1987 and 1992 and stopped in 1996 under the auspices of the French national programme, Association France Hypophyse. They then were able to record adult heights for 76% of these patients. Gain in height was on average a disappointing 1.1 (0.9 SD). Overall, the treatment of a child for about three years (certainly not “long term”) was associated with an estimated gain in height of only 4.2 cm. Faced with these unimpressive results, the authors conclude with understandably muted enthusiasm that (a) the effect of growth hormone is unclear in many patients treated for idiopathic isolated growth hormone deficiency and that many patients may have simple constitutional delay of growth and development, and (b) only patients with “severely and permanently” altered growth hormone secretion should be treated with growth hormone.

We have been treating growth hormone deficiency with growth hormone in children for over four decades.2 The paper by Carel et al would suggest that …