Symptomatic versus substitution growth hormone therapy in short children: From auxology towards a comprehensive multidimensional assessment of short stature and related interventions

There is an ongoing debate as to whether symptomatic growth hormone treatme nt (GHT) in short children without growth hormone deficiency (GHD) is justi fied, since there is no substitutional indication, The increasing evidence that final height cannot be normalized in these patients (e.g, in Ullrich-T urner syndrome) reinforces this controversy, We have focused on the empiric al evidence on the psychosocial and physical meaning of being short in chil dhood as well as on the underlying assumptions of the different GHT indicat ions. The indication for GHT in patients with non-GHD may be seen as a phar macotherapeutic intervention in order to prevent the developmental, physica l and psychosocial risks associated with short stature, This requires a qua litative shift in methodological assessment with respect to the psychosocia l and physical impact of being short as well as of the potential benefit of new treatment indications in terms of a more comprehensive evaluation incl uding health-related quality of life for these patients.