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Controversies in the diagnosis and management of growth hormone deficiency

Growth hormone deficiency is a rare cause of short stature (prevalence 1 in 4000). Although rare it is an important diagnosis to make correctly as therapy with growth hormone is highly efficacious and so a missed diagnosis will result in a poor outcome and equally a false positive diagnosis will lead to many years of daily subcutaneous injections, significant wasted expenditure and unnecessary exposure to potential adverse effects. In a comprehensive review, Murray and colleagues discuss the significant controversies in the diagnosis and management. Growth hormone stimulation tests play a key role in diagnosis but measured levels can vary significantly with the stimulation test and assay used. Different aspect of treatment are covered including starting dose (controversial), monitoring and when to stop treatment. At the end of growth a number of young people re test normal and it is not clear whether this reflects transient deficiency or a false positive diagnosis. This review is extensive and helpful and emphasises the importance of a careful and correct diagnosis and early reassessment if the growth hormone deficient child responds poorly to treatment with growth hormone …

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