Terminating growth-promoting growth hormone therapy: In favor of the "normal opportunity range"

The determining of a responsible endpoint for growth hormone (GH) prescript ions for growth promotion in all conditions remains problematic. Dr. David Allen, a pediatric endocrinologist, pro. poses that treatment that is stopp ed when height is within the normal adult range represents not only a succe ssful therapeutic outcome, but also a reasonable allocation of resources an d preservation of a proper goal for the medical profession. On the other ha nd, because many children with unexplained isolated GH deficiency (GHD) dis play normal GH secretion after puberty, continuous treatment to maximal hei ght may include years of unnecessary treatment, during which time GH therap y becomes increasingly expensive and, simultaneously, less effective as fin al height is approached. From an ethical standpoint, Allen argues that prom oting additional growth within the normal adult range can be viewed as enha ncement and not treatment. Dr. Michael Kappy, pediatric endocrinologist, co unters that using the lower range of adult height as a goal represents a "g ender-biased" definition of handicap rather than a functional one. Instead, the criterion for discontinuing GH should be purely physiological, i.e., h ow tall the child would have grown if he or she did not have GHD. He argues that this approach is less arbitrary and minimizes the frustration of valu e judgment by the physician.