Growth hormone in the treatment of children with short stature.

Replacement of GH in GH-deficient children is the only established indication for GH therapy. Treatment of all non-GH-deficient patients must be considered experimental. There is a pressing need for carefully controlled clinical trials of the effect of GH in patients with constitutional growth delay, intrauterine growth retardation, and Turner's syndrome. Research is needed to develop reliable methods for predicting which short, non-GH-deficient children will respond to GH therapy. GH is a potent metabolic agent, and its safety when used in pharmacologic doses for treatment of short, non-GH-deficient children has not been established. Until adequate experience is gained under controlled conditions, GH should not be used indiscriminately. As the investigational use of GH is expanded, researchers and clinicians should bear in mind that handicaps resulting from short stature often have psychological origins. Therefore, even for experimental studies, GH therapy should be restricted to children in whom it is judged that emotional status can be significantly improved. The potential for benefit should outweigh the problems of long-term parenteral therapy. In selecting patients for GH trials the wise physician might adhere to the old adage, "If it ain't broke, don't fix it."