In 1985, approval of recombinant human growth hormone (rhGH) made available a virtually unlimited resource to replace human pituitary–derived GH, which had been withdrawn for safety concerns. During the ensuing 2 decades, clinical trials spearheaded by pediatric endocrinologists and supported primarily by manufacturers of rhGH strived to show that rhGH treatment could improve growth rates and eventual height in children without growth hormone deficiency (GHD) who are short as a result of (sequentially) Turner syndrome (TS), chronic renal insufficiency (CRI), small for gestational age (SGA), Prader-Willi syndrome (PWS), or idiopathic short stature (ISS). Approval of these new indications validated the notion, first proposed in 1990,1 that if rhGH treatment is effective at increasing height in non-GHD children, then the etiology of short stature is not morally relevant in deciding who is entitled to treatment. These children all share a central and seemingly valid concern: “I am short and I...
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July 2006
Special Articles|
July 01 2006
Growth Hormone Therapy for Short Stature: Is the Benefit Worth the Burden?
David B. Allen, MD
David B. Allen, MD
Department of Pediatrics, University of Wisconsin Children's Hospital, Madison, Wisconsin
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Address correspondence to David B. Allen, MD, Department of Pediatrics, University of Wisconsin Children's Hospital, H4/448 CSC–Pediatrics, 600 Highland Ave, Madison, WI 53792-4108. E-mail: [email protected]
Pediatrics (2006) 118 (1): 343–348.
Article history
Accepted:
February 03 2006
Citation
David B. Allen; Growth Hormone Therapy for Short Stature: Is the Benefit Worth the Burden?. Pediatrics July 2006; 118 (1): 343–348. 10.1542/peds.2006-0329
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Comments
Growing Normally or NOT?
Sirs, Dr Allen is to be congratulated on this article published in Vol 118. He provides a balanced view of the indicated uses of GH in the USA.
We take issue with two important facts; Firstly, children with Idiopathic Short Stature (ISS)are not growing at a normal rate and often are not at an appropriate height for their genetic expectation. The cause of their growth failure is simply not known at this time, as advances in science occurr we may well discover the reason for this growth abnormality, right now we should be offering our children the best that medicine has to offer, rhGH.This is not a cosmetic issue. Secondly, Dr Allen states that 'enthusiasm and support for rhGH treatment will surely wane in the future', on the contrary as advances and uses of rhGH expand,as a profession we should be encouraging our colleaugues in the biotechnology industry to invest in clinical research into broader uses of rhGH in many of the metabolic and chronic diseases that impact the lives of our patients.
Susan L Smith RN CDE CNS PNP
Conflict of Interest:
None declared