4 Treatment of growth hormone deficiency

According to the results reported in the literature and from our own experience, the following recommendations for the treatment of children with GHD can be given:

• 1.

  In order to start GH replacement therapy in early childhood the diagnosis of GHD should be made as early as possible.

• 2.

  The growth hormone dose during prepubertal age should not fall short of 12 IU/m² per week. During spontaneous or induced puberty, the dose needs to be increased, possibly by a factor of two. Daily subcutaneous injections appear most suitable. Treatment with growth hormone releasing factors in cases with hypothalamic GHD, although a promising alternative to the treatment with hGH (Thorner et al, 1985), must be considered experimental at this point.

• 3.

  Thyroxine replacement at a daily dose of 75–100 μg/m² should be given in cases of secondary hypothyroidism.

• 4.

  Glucocorticoid replacement, if required, should be given at low doses (e.g. hydrocortisone 10 (to 15) mg/m² per day in divided doses).

• 5.

  In cases with additional gonadotropin deficiency, sex steroids (or anabolic steroids) should be given with frequent monitoring of bone maturity not before the age of 13 in girls or 15 years in boys. In boys depot testosterone starting at low doses (e.g. 50–100 mg/month i.m.) will induce a puberty-like increment in height velocity. Since the effect of oestrogens—even in low doses—on growth is uncertain, their administration before achievement of near-normal adult height should be avoided.

With the advancement of diagnostic techniques and with the experience in treatment accumulated over the past 25 years, patients with GHD need no longer become dwarfs.