SHORT STATURE AND GROWTH-HORMONE THERAPY - A NATIONAL STUDY OF PHYSICIAN RECOMMENDATION PATTERNS

Objective.-To determine current expert opinion and recommendations reg arding the controversial issue of the use of growth hormone (GH) to tr eat short children who do not have classical GH deficiency (non-GHD ch ildren). Study Design.-Analysis of a national survey mailed to 534 US physician experts on the management of short stature (pediatric endocr inologists) with a response rate of 81.3%. Main Outcome Measure.-The e xperts' GH treatment recommendations. Results.-The physicians reported that approximately 58% of their current patients undergoing GH therap y have classical GH deficiency, while 42% have other conditions. The p roportion of physicians who recommended GH treatment of short non-GHD children ranged from 1% to 74% over all case scenarios presented. The likelihood of GH being recommended depended on the physiological growt h characteristics of the child tie, the child's height, growth rate, a nd predicted adult height), contingency factors tie, strong family wis hes or a reduction in GH cost), and physician beliefs tie, the impact of short stature on well-being, the effectiveness of GH therapy), Each of these factors exerted highly significant, independent, and additiv e effects on decisions to recommend GH. Conclusion.-Our results indica te that many pediatric endocrinologists consider GH treatment appropri ate for selected short non-GHD children, going beyond current Food and Drug Administration-approved indications for GH. Decisions to recomme nd GH for a non-GHD child rest on a combination of medical, social, an d perceptual factors; variations in treatment patterns stem from varia tions in these influences. Future GH use will likely be determined not only by the results of controlled trials, but also by family preferen ces, producer pricing, and physician perceptions of the value of heigh t and GH therapy.