Dosing of growth hormone in growth hormone deficiency

Growth hormone (GH) treatment of GH-deficient (GHD) children is to a certai n extent standardized worldwide. Recombinant 22 kDa GH is injected once dai ly by the subcutaneous route, mostly in the evening. The amount of GH injec ted (calculated per kg body weight or body surface area, expressed in terms of IU or mg) in prepubertal children mimics the known production rate (app roximately 0.02 mg [0.06 IU]/kg body weight per day). However, there is a w ide variation in dosage, the reasons for which are partly unknown and partl y due to national traditions and regimes imposed by authorities regulating reimbursement. The situation during puberty is less standardized, with most clinicians still not increasing the dosage according to known production r ates. The results of these approaches in terms of adult height outcome are not always satisfactory. In order to achieve optimal height development dur ing childhood, puberty and adulthood, strategies must be developed to indiv idualize GH dosing according to set therapeutical goals taking into account efficacy, safety and cost. The implementation of prediction algorithms wil l help us to reach these goals. In addition, other response variables will have to be monitored during treatment in order to correct for deficits resu lting from GHD. Copyright (C) 1999 S. Karger AG, Basel.