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Idiopathic Short Stature: Decision Making in Growth Hormone Use

  • Symposium on Growth Hormone
  • Published:
The Indian Journal of Pediatrics Aims and scope Submit manuscript

Abstract

Short stature is a common concern in pediatrics. Several ambiguities and controversies persist, especially with regard to criteria, cost, medical necessity and outcomes of growth hormone (GH) therapy for idiopathic short stature (ISS). Due to these ambiguities and controversies, a series of decisions by primary care physicians (whether to refer the short child to a pediatric endocrinologist), pediatric endocrinologist (whether to recommend GH treatment), families (whether to raise concern about short stature and whether to agree to undertake treatment), and third party payers (whether to cover the costs of GH therapy) influence which individual short children will receive GH in the US. Together, these decisions determine overall GH use. Apart from child’s growth characteristics, several non-physiological factors drive the critical decisions of these stakeholders. This article focuses on current ambiguities and controversies regarding GH therapy in ISS, discusses the decision-makers involved in GH therapy, and explores the factors influencing their decisions.

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Notes

  1. Additional FDA criteria for the use of GH in ISS include growth rate unlikely to permit attainment of adult height in the normal range, epiphyses not closed and diagnostic evaluation excluding other causes of short stature that should be observed or treated by other means.

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Role of Funding Source

The work described in this paper was supported in part by a grant from the NIH (LC) and by a grant from the Rainbow Babies and Childrens Hospital Foundation.

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Authors and Affiliations

  1. Division of Pediatric Endocrinology and Diabetes, The Center for Child Health and Policy, Department of Pediatrics, Rainbow Babies and Children’s Hospital, Case Western Reserve University, 11100 Euclid Avenue, Room 737, Cleveland, OH, 44106, USA

    Nidhi Maheshwari, Naveen K. Uli, Sumana Narasimhan & Leona Cuttler

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  1. Nidhi Maheshwari
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  2. Naveen K. Uli
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  3. Sumana Narasimhan
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  4. Leona Cuttler
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Correspondence to Leona Cuttler.

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Maheshwari, N., Uli, N.K., Narasimhan, S. et al. Idiopathic Short Stature: Decision Making in Growth Hormone Use. Indian J Pediatr 79, 238–243 (2012). https://doi.org/10.1007/s12098-011-0607-6

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  • DOI: https://doi.org/10.1007/s12098-011-0607-6

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