THE SAFETY AND EFFECTIVENESS OF HUMAN GROWTH-HORMONE USING PHARMACOLOGICAL DOSING

Human growth hormone in currently recommended dosage is effective in m any short children, irrespective of their endogenous growth-hormone st atus. This suggests that present dosing is pharmacological rather than physiological. As for any drug, issues of safety should be of paramou nt concern. Reassuring short-term data with pharmacological dosing or long-term data with replacement dosing cannot guarantee the ultimate s afety of this form of therapy. The risk of future malignancy should be of particular concern. Poorly growing children without classic (sever e) growth-hormone deficiency constitute an increasing proportion of ch ildren treated with human growth hormone. There are no satisfactory cr iteria for the diagnosis of neurosecretory growth-hormone dysfunction. The closer to puberty these children are treated, the less likely it is that there will be benefits in terms of increased final height. Rec ommendations as to a 'safety first' approach to growth-hormone treatme nt are given. A multicentre controlled trial is urgently needed to est ablish the benefits of treating children with neurosecretory growth ho rmone dysfunction.