[Current developments in the treatment of growth delay using growth hormone]

In this paper five new developments in the field of growth hormone (GH) deficiency and its treatment are discussed. Firstly, the changing concepts on the definition of GH deficiency are described. The main criteria for GH deficiency are a low growth velocity and a decreased GH secretion, but for none of these parameters clear limits can be drawn. Secondly, the results of GH therapy in children with normal GH responses to provocative stimuli are reviewed. Growth velocity does increase in many of these children, but it is not yet known if the final height will increase. Thirdly, new modes of administration are discussed, as well as the GH dosage and the frequency of injections. Daily subcutaneous administration seems to be superior in terms of growth promoting effect. The fourth new development, the production of biosynthetic GH, is certainly the most important. This will soon lead to an unlimited supply of GH with great consequences for the type of patients that will be treated and for the dosage that will be given. Finally, the pharmacological agents which can stimulate the GH secretion are described, particularly growth hormone releasing factor (GRF). The therapeutical use of GRF is still in an experimental phase. In the present circumstances it is very important that GH therapy be given in a well standardized way. For the time being concentration of patients into the centres of pediatric endocrinology will remain advantageous.