Therapy with growth hormone--old and new indications

Pituitary dwarfism with severe growth hormone deficiency (GHD) represents the classical indication for treatment by recombinant human growth hormone (hGH). With continuous GH replacement and early start of treatment, normal adult height can be achieved. During puberty the dosage of hGH administered should be increased. Numerous growth disorders do not coincide with major GHD as determined by provocative tests but only with diminished spontaneous hormone secretion. Typical examples are constitutional delay of growth and adolescence and growth retardation after irradiation of the skull. Also in these disorders treatment by recombinant hGH in replacement doses renders favorable results. The more normal the spontaneous GH secretion is, e.g. in familial short stature and in skeletal dysplasias, the higher doses of GH are needed to stimulate growth. For treatment of patients with Turner's syndrome a combined therapy with high doses of GH and with oxandrolone has proven rather effective. With endogenous and exogenous hypercortisolism the metabolic balance is shifted towards catabolism and spontaneous GH secretion is depressed. In such situations, e.g. after severe traumas, operations, infections and combustions, administration of GH can be rather helpful. Recent trials in children with stunted growth due to chronic renal insufficiency show that it is possible also in this condition to effectively stimulate growth by hGH.