Optimization of growth hormone therapy in growth hormone deficient children.

Successful treatment with human growth hormone (hGH) was initially reported by Raben in 19581. Although itis well established that pituitary derived or biosynthetic hGH increases the growth rate in growth hormone deficient children, many patients that were treated in the early days have not reached their target height, or attained adult height below the third percentile of population standards 2" 5. Several explanation have been suggested for these disappointing results. In the earlier days treatment was started at a rather late age and therefore a substantial growth potential has been lost already. Several investigators found positive correlation between final height, height standard deviation score (SDS) for chronological age (CA) or bone age (BA) and height at the start of treatment, stressing the importance of early diagnosis and treatment to prevent further loss of height 3'4'6. Another contributing factor might be