Letters to the Editor

Growth hormone deficiency in children with chromosomal abnormalities SIR,-I read with some surprise the letter by Schwartz and Duck on the treatment with growth hormone of two children with chromosome deletions associated with multiple mal-formations, microcephaly, and mental handicap.' Though I too am intrigued that a cause of poor growth in some children with chromosome disorders might be mediated through a lack of growth hormone (although I cannot understand why they used growth hormone in their second case, as there was a very adequate maximum growth hormone response to insulin provoked hypoglycaemia (21-4 mIU/1)), this has surely to be tempered with a sense of proportion. Is it really appropriate clinical practice to use growth hormone in children with such major multiple physical and neurodevelopmental handicaps? This example highlights for me what is becoming an increasingly worrying dilemma concerning growth hormone treatment. If, to children with true growth hormone deficiency , we add girls with Turner's syndrome, children who fail to grow as a consequence of intracranial irradiation for treatment of malignant disorders, children with other chronic diseases such as chronic renal failure, and now children with chromosome disorders and dys-morphisms, the queue for growth hormone treatment, an extremely costly item, becomes a long one. This is even without 'normal' short children whose treatment with growth hormone is surely an option we should now very seriously question. Against a background of increasing financial constraints within health authorities the euphoria following the ready availability of biosynthetic preparations of growth hormone in 1985 will need to be better disciplined. Because growth in the short term can be accelerated after administration of growth hormone , and because there might also result an increase in predicted height of a few centimetres , does not mean it has to be used; this is an assumption that seems to be insidiously becoming part of paediatric practice. More needs to be learned, beyond simple anecdotal experience, of possible detrimental effects to psychological wellbeing of shortness, which is often the major criterion for considering treatment. We also need to look in more detail at psychological outcomes of treatment. The problem of shortness is often as much a family concern as it is one belonging to the child, and parents' attitudes have to be better understood, as herein so often lies the source of the problem. At the same time we need to do as much as we can to …