With graduation season in full swing, recent medical school graduates will soon be entering hospitals across the country as interns for the first time. Thinking back to my own time in medical school, I am amazed at how many new types and classes of drugs have emerged. Each year, pharmacology curriculums become denser and more robust. I am grateful to have attended medical school when I did; there were so many fewer medications to learn!
Today, there are more drugs than ever, offering multiple therapeutic options and classes for innumerable conditions. Asthma can be treated with short- and long-acting beta agonists, inhaled steroids, leukotriene modifiers, and biologics. Similarly, inflammatory bowel disease has treatments like aminosalicylates, immunomodulators, biologics, and small molecule drugs. Indeed, there is seemingly no end to the medications available to treat hypertension and hypercholesterolemia.
However, more is not necessarily better. Pediatric endocrinologists, when faced with a patient with growth hormone deficiency, are singularly and uniquely equipped to manage this condition with recombinant human growth hormone (rhGH), the sole therapeutic class approved for such. The June 2025 issue of Pediatrics in Review features the article titled “Short Stature for the General Pediatrician” by Dr. Diaz and colleagues, discussing, among many items, the use of rhGH. However, rhGH’s introduction to the field has a notable course.
Before 1985, growth hormone extracted from the pituitary glands of human cadavers was the treatment of choice for those with growth hormone deficiency. However, the recognition of Creutzfeldt-Jakob disease in patients treated with such hormones briefly left a treatment void that was fortunately filled quite quickly in a manner of months by rhGH. Approved for use 40 years ago this fall, rhGH was the second drug made using recombinant DNA (rDNA) technology—a topic, much like pharmacology, I knew much better in medical school than I do now. Such technology continues to be used in drug and vaccine development today. Notably, pediatric endocrinology has also benefited from the first medicine made using rDNA technology: insulin.
I think it is quite impressive that one pediatric sub-specialty, with only about 1500 providers in the US, has benefited so immediately and so immensely twice in its history from the development of new first-in-class drugs, without the “trickling down” from the adult world that is seen in the use of so many other therapeutics today. The immediate use of insulin and rhGH to aid in the safe management of type I diabetes and growth hormone deficiency has served pediatric endocrinology patients notably well. I am left to wonder where the field will be in another forty years when today’s medical school graduates will be wrapping up their careers.
