Clinical and humanistic aspects of growth hormone deficiency and growth-related disorders

Growth hormone (GH) therapy has evolved rapidly since the introduction of recombinant human GH (rhGH). The increase in the availability and safety of GH therapy has also increased the number of US Food and Drug Administration (FDA) indications for use in both children and adults. FDA indications in children include GH deficiency (GHD), Turner syndrome, idiopathic short stature, small for gestational age with failure to attain normal growth percentiles, Prader-Willi syndrome (PWS), chronic renal insufficiency, Noonan syndrome, and short stature due to short stature homeobox gene haploinsufficiency. Children and adolescents with GHD have demonstrated the greatest response to GHD therapy. The primary objective of rhGH therapy in children is to increase height velocity; however, the therapy also has benefits related to improved body composition, especially in children with conditions like PWS. Treatment of adult GHD primarily targets improvements in body composition, quality of life, and surrogate markers for cardiovascular disease. The safety reports of rhGH in children are generally good, but there have been a small number of cases of raised intracranial pressure, scoliosis, and muscle and joint discomfort. In adults, many side effects can be managed with dose titration at the initiation of treatment and dose reduction if side effects occur.