When growth hormone (GH) could only be obtained from cadaver pituitaries, little doubt existed about which short children needed treatment.

The expensive treatment was reserved for children with severe growth hormone deficiency (GHD), at risk of reaching an adult height of only 3 1/2 or 4 1/2 feet.

Since recombinant GH became available in 1985, however, it has been tried for "just about everything that's short," including so-called "normal short" children, said Louis Underwood, M.D., FAAP, chief, Division of Endocrinology, Department of Pediatrics, University of North Carolina at Chapel Hill. These children with idiopathic short stature or constitution- "It may be that you accelerate growth but you don't affect the ultimate height these patients achieve," he explained. "Is being a taller adolescent, but not a taller adult, a reasonable goal? There are a couple of studies showing modest gains in adult stature, based on predicted height, and is that modest gain enough?"

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