Psychosocial Stresses Related to Short Stature: Does Their Presence Imply Psychological Dysfunction?
David E. Sandberg Patricia Michael State University of New York at Buffalo Children's Hospital of Buffalo
Before 1985, cadaveric pituitaries constituted the only source of growth hormone (GH) for the endocrine management of growth failure and short stature (SS). Because supplies of the hormone were extremely limited during that treatment era, the eligibility of patients was, understandably, guided by the principle of hormone-replacement. Thus, only those youth exhibiting "classical" GH- deficiency in pharmacological challenge tests were routinely eligible for treatment; even then, supplies were frequently inadequate so that only a minority of those treated ever achieved their full genetic potential for adult height ( Dean, 1990).
The development of biosynthetic GH eliminated the problem of limited hormone availability and led to a dramatic increase in the number of children receiving treatment ( Lippe & Nakamoto, 1993). At present, it can be inferred from prescribing practices that poor growth velocity in an otherwise healthy short child has, de facto, become an additional indication for a trial of GH therapy ( Allen & Fost, 1990). This expanded clinical use of GH has not, however, occurred without controversy ( Guyda, 1996).