Growth hormone in growth hormone deficiency

BMJ 2002; 325 doi: https://doi.org/10.1136/bmj.325.7371.1037/c (Published 02 November 2002) Cite this as: BMJ 2002;325:1037

Ignore the evidence and keep going wrong

  1. Jean-Claude Carel, professor of paediatrics, department of paediatric endocrinology,
  2. Emmanuel Ecosse, statistician, department of biostatistics,
  3. Joël Coste, professor, department of biostatistics
  1. Groupe hospitalier Cochin-Saint Vincent de Paul and Faculté Cochin, Université Paris V, F-75014 Paris, France
  2. Servizio di Endocrinologia Pediatrica, Ospedale Regionale per le Microcitemie, Via Jenner, 09121 Cagliari, Italy
  3. Clinica Pediatrica, Università di Pavia, Policlinico San Matteo, IRCCS, Piazzale Golgi, 2, 27100 Pavia, Italy
  4. U O di Auxologia, Ospedale Bambino Gesù, IRCCS, Via Torre di Palidoro, 00050 Palidoro, Rome, Italy

    EDITOR—We were surprised that in his editorial to our paper Saenger challenged our conclusions that most patients treated for growth hormone deficiency do not have this condition, and that controlled trials should be organised to evaluate the long term effects of growth hormone in most of the patients currently treated.1 Saenger supports the use of an integrated approach to diagnosing growth hormone deficiency and the wider use of IGF-1 measurements, as suggested by the Growth Hormone Research Society. However, his recent publications, as coauthor or senior author, do not reflect his plea.2 3 This contradiction reflects the widespread contrast between the recommendations in consensus guidelines and current practice or clinical research protocols.

    In the absence of a gold standard, how can growth hormone deficiency be defined? We propose using long term results of treatment in comparison with spontaneous outcome. The results of our observational study indicate that most …

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