Clinical review 11: the rational use of growth hormone during childhood.

The virtually unlimited availability of hGH manufactured by recombinant DNA technology raises a number of difficult questions with regard to the rational use of this material in the management of short stature in childhood. The theoretical limits of such use range from the restriction of GH therapy to patients with classical GH deficiency, with the goal of achieving genetic growth potential, to providing GH for any child whose height is more than 2 SD below the mean for age regardless of etiology, with the goal of improving on genetic growth potential. This analysis will attempt to locate and hold a position somewhere between these two extreme poles. Our citations in this review are limited to recent studies employing recombinant hGH (rhGH). We will begin on solid ground and move across less firm terrain hoping to stop before losing our footing altogether.