The area of growth hormone therapy has been shrouded in controversy for several years. In the US, anxious parents apply pressure on doctors so their little ones can receive this elixir, regardless of whether there is a medical condition to treat. More recently, health care organisations have balked at the very high cost of growth hormone therapy, and with a greater consciousness of evidence-based medicine, there is also growing concerns about its efficacy. There are now fears about the safety of long-term growth hormone administration with possible risks of increased cardiovascular disease and diabetes, although the latter seems to be a temporary phenomenon. At the clinical level there are also uncertainties about proper optimum dosing schedules used for both children and adults, as well as how to manage the transition from childhood to adulthood (when to stop giving the hormone and how to follow up). Challenges in Growth Hormone Therapy tackles these issues and provides a timely and controversial review of these topics for endocrinologists and paediatricians.
Table of Contents
1 GH replacement in children - what is the optimum dosing schedule?.
2 What is the current status of GH therapy in children with Turner's syndrome?.
3 Is there a role for GH therapy in Noonan's syndrome?.
4 Does GH therapy influence final height in skeletal dysplasia syndromes?.
5 Is there a role for GH therapy in short normal children?.
6 What is the role of GH therapy in children born small for gestational age?.
7 Is cardiovascular mortality increased in hypopituitary adults?.
8 How should we diagnose GH deficiency in hypopituitary adults?.
9 What is the impact of GH deficiency on bone density in childhood-onset and adult-onset GH deficiency, and how effective is GH replacement?.
10 Individual susceptibility and GH dosing regimen in adults.
11 What is the impact of GH deficiency and GH replacement on quality of life in childhood-onset and adult-onset GH deficiency?.
12 Is there an upper limit for GH replacement in hypopituitary adults?.
13 Is open-ended GH replacement a safe therapy?.
14 How should we evaluate GH treated patients at completion of linear growth?.
15 How should we transfer patients from paediatric to adult clinics?.
16 Is there a role for GH therapy in osteoporosis and in ageing?.
17 What is the current status of GH therapy in catabolic adults?.
18 Is GH therapy indicated in the metabolic syndrome?.
19 Does GH therapy have a role in management of cardiac failure?