THE UNBEARABLE LIGHTNESS OF PRESCRIBING GROWTH HORMONE

Abstract

Short stature is the most visible and prominent physical characteristic and one of the commonest reason for referral to pediatric endocrinologist. It is assumed as disabling condition with psychosocial consequences that seeks treatment. Behind short stature severe pathology could be hidden, although not necessarily of endocrine origin. Even in the new millennium, many diagnostic pitfalls and dilemmas persist in confirmation of growth hormone deficiency (GHD), the first indication that fits in endocrine paradigm: to replace the missing hormone. In 1985 FDA approved recombinant human GH (hGH) as the treatment of pediatric patients who have growth failure due to inadequate secretion of endogenous GH. Availability of hGH in unlimited amounts enhanced the number of indications of GH use. Pediatric endocrinologist started to promote and to apply use of hGH for height in short, but otherwise healthy children, with hormonal normalcy. Reasonable criticism of such praxis arises in the light of recent safety alerts. The unbearable lightness of prescribing growth hormone to every apparently or really short child is reaching epidemic progress in Serbia. When authorities in this low income country (estimated as developing), approved hGH for use in SGA (small for gestational age) children, use and misuse of hGH exploded. Socially acceptable height, the term applied by some endocrinologists actually means that society does not accept short people. The pharmaceutical companies go even further offering, besides growth acceleration, better and brighter future for potential patients, in whom the self-confidence is measured by centimeters of height. However, benefits of such treatment on quality of life were never confirmed. Children with severe growth failure and documented GHD should be treated undoubtedly, but use of hGH for height, so called cosmetic endocrinology, needs critical appraisal. Children and their parents should be informed about height prediction and long-term consequences.