Authors' objectives:

To provide guidance on the use of human growth hormone (somatropin) in children with growth failure.

Authors' recommendations: Guidance: 1.1 Recombinant human growth hormone (somatropin) treatment is recommended for children with proven clinical diagnosis of growth hormone (GH) deficiency supported by appropriate auxological, biochemical and radiological investigations. 1.2. GH treatment is recommended for children with Turner syndrome (TS). The following issues should be taken into consideration in order to maximise the benefit from this treatment: - diagnosis and treatment at earliest age possible - appropriate timing and use of oestrogen therapy. 1.3. GH treatment is recommended for pre-pubertal children with chronic renal insufficiency (CRI) providing: nutritional status has been optimised - metabolic abnormalities have been optimised - steroid therapy has been reduced to minimum. 1.4. GH treatment is recommended for children with Prader-Willi syndrome. 1.5. GH treatment should, in all circumstances, be initiated and monitored by a paediatrician with special expertise in the management of children with GH disorder. Continuation of treatment can be maintained under an agreed shared-care protocol with a general practitioner. 1.6. GH treatment should be re-evaluated and normally discontinued if there is a poor response to treatment, defined as an increase in growth velocity of less than 50% from baseline, in the first year of therapy. Ongoing response should be evaluated against expected growth based on standard growth charts. Therapy should normally be stopped when final height is approached and growth velocity is less than 2 cm total growth in 1 year. Persistent and uncorrectable problems with adherence to treatment should also be taken into account as part of re-evaluation of treatment. In Prader-Willi syndrome evaluation of response to therapy should also consider body composition. 1.7. After attainment of final height, GH therapy will normally be discontinued, but it should not be discontinued by default. The decision to stop treatment should either be made by a paediatrician with special expertise in the management of children with GH disorders in cnsultation with patient and carers, or therapy should be continued until re-evaluation by an adult endocrinologist has been undertaken. The transition to adult care for people with GH disorders will require a close collaboration between the responsible clinicians. 1.8. In children with CRI, GH treatment should be stopped after renal transplantation. It should not normally be re-started until at least 1 year after renal transplantation to allow time to ascertain whether catch-up growth will occur. 1.9. The use of GH therapy in children with idiopathic short stature is currently not licensed, and therefore it was not considered as part of this appraisal.

Authors' methods: Systematic review

Project Status: Completed

URL for project: http://www.nice.org.uk/cat.asp?c=32239

Year Published: 2002

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: England, United Kingdom

Organisation Name: National Institute for Clinical Excellence

Contact Address: MidCity Place, 71 High Holborn, London WC1V 6NA, UK. Tel: +44 020 7067 5800; Fax: +44 020 7067 5801

Contact Name: nice@nice.nhs.uk

Contact Email: nice@nice.nhs.uk

Copyright: National Institute for Clinical Excellence (NICE)