Optimal therapy of growth hormone deficiency in the child and adolescent

Abstract

Optimal therapy of growth disorders depends on accurate diagnosis and clear goals for therapy. Understanding normal patterns of growth hormone (GH) and insulin-like growth factor secretion are necessary to appreciate the different hormone pattern induced by therapy. Finally, monitoring efficacy and safety, identifying interfering factors, and adjusting doses, are all part of optimizing GH therapy in childhood GH deficiency (GHD). Prevention of development of GHD would avoid the need for therapy. Options for optimizing GH therapy in childhood GHD include initiating treatment as young as possible, facilitating adherence to therapy plan, and adjusting GH dose on an individual basis to achieve 'target' results. In addition, there can be consideration of regulating timing of puberty, use of higher GH doses, and improving the process of transition from pediatric to adult care. Future prospects include improved depot GH preparations or alternative delivery systems. Development of depot GH-releasing hormone/peptide therapy could allow a more physiologic pattern of GH secretion. GH therapy should be targeted to yield the best growth response, best safety profile, and the best psychosocial adjustment.