Ljiljana Šaranac

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Short stature is the most visible and prominent physical characteristic and one of the commonest reason for referral to pediatric endocrinologist. It is assumed as disabling condition with psychosocial consequences that seeks treatment. Behind short stature severe pathology could be hidden, although not necessarily of endocrine origin. Even in the new millennium, many diagnostic pitfalls and dilemmas persist in confirmation of growth hormone deficiency (GHD), the first indication that fits in endocrine paradigm: to replace the missing hormone. In 1985 FDA approved recombinant human GH (hGH) as the treatment of pediatric patients who have growth failure due to inadequate secretion of endogenous GH. Availability of hGH in unlimited amounts enhanced the number of indications of GH use. Pediatric endocrinologist started to promote and to apply use of hGH for height in short, but otherwise healthy children, with hormonal normalcy. Reasonable criticism of such praxis arises in the light of recent safety alerts. The unbearable lightness of prescribing growth hormone to every apparently or really short child is reaching epidemic progress in Serbia. When authorities in this low income country (estimated as developing), approved hGH for use in SGA (small for gestational age) children, use and misuse of hGH exploded. Socially acceptable height, the term applied by some endocrinologists actually means that society does not accept short people. The pharmaceutical companies go even further offering, besides growth acceleration, better and brighter future for potential patients, in whom the self-confidence is measured by centimeters of height. However, benefits of such treatment on quality of life were never confirmed. Children with severe growth failure and documented GHD should be treated undoubtedly, but use of hGH for height, so called cosmetic endocrinology, needs critical appraisal. Children and their parents should be informed about height prediction and long-term consequences.


Growth Hormone Use, GHD, SGA, ISS, Short Stature, Cosmetic Endocrinology.

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Bailey JD. Foreword. Clinics in endocrinology and metabolism 1982; 11: 9-16.

Rosenfield RG. Ten axioms in the evaluation of growth failure. The Endocrinologist 1997; 7: 148-152.

Scherdel P, Dunkel L, Van Dommelen P, Goulet O, Salaun JF, Brauner et al. Growth monitoring as an early detection tool: a systematic review. Lancet Diabetes Endocrinol 2016, http://dx

Raben MS.Growth hormone-clinical use of growth hormone. NEJM 1962; 266: 82-86.

Gandrud LM, Wilson DM. Is growth hormone stimulation testing in children still appropriate? Growth Horm&IGF Res 2014; 14: 185-194.

Pampanini V, Pedicelli S, Gubinelli J, Scire G, Cappa M, Boscherini B et al. Brain magnetic resonance imaging as first-line investigation for growth hormone deficiency diagnosis in early childhood. Horm Res Paediatr 2015; 84: 323-330.

Grimberg A, DiVall SA, Polichronakos C, Allen DB, Cohen IE, Quintos JB et al. Guidelines for growth hormone and insulin-like growth factor-I treatment in children and adolescents: growth hormone deficiency, idiopathic short stature, and primary insulin-like growth factor deficiency. Horm Res Padiatr 2016; 86: 361-397.

Argente J. Challenges in the management of short stature. Horm Res Paediatr 2016; 85: 2-10.

Allen DB.Lessons learned from the hGH era. JCEM 2011; 96: 3042-3042.

Allen DB. Short stature in childhood-challanges andchoises. NEJM 2013; 368: 1220-1228.

Laventhal NT, Shuchman M, Sandberg DE. Warning about warnings: weighing risk and benefit when information is in a state of flux. HormRes Pediatr 2013; 79: 4-8.

De Vries MC. A tango for four: deciding on growth hormone therapy in idiopathic short stature. Horm Res Paediatr 2013; 79: 2-3.

Campbell EG, Weissman JS, Ehringhaus S, Rao SR, Moy B, feibelman S, Goold SD. Institutional academic-industry relationships. JAMA 2007; 298: 1779-1786.

Moynihan R, Health I, Henry D. Selling sickness: the pharmaceutical industry and disease monitoring. BMJ 2002; 324: 886-891.

Allen DB. Growth promoting ethics and the challenge to resist cosmetic endocrinology. Horm Res Paediatr 2017; 87: 145-152.

Adelman M. Gene test for growth hormone deficiency developped.Medicine&health/Medical research2018

Laron Z. Extensive personal experience. Laron syndrome (primary growth hormone resistence or insensitivity):the personal experience 1958-2003. J Clin Endocrinol Metab 2004; 89: 1031-1044.

Alatzoglou KS, Webb EA, Tissier Pl, Dattani M. Isolated growth hormonedeficiency (GHD) in childhood and adolescence. Endocrine Rev 2014; 35: 376-432.

Aberg D. Role of the growth hormone/insulin-like growth factor 1axis in neurogenesis. Endocr Dev 2010; 17: 63-76.

Russo VC, Gluckman PD, Feldman EL, Werther GA. The insulin-like growth factor system and its pleiotropic functions in brain. Endocr Rev 2005; 26: 916-943.

Allen DB. Fost NC. Growth hormone therapy for short stature: panacea or Pandora's box. J Pediatr 1990; 117: 16-21.

Allen DB. Cost-concious growth-promoting treatment: when discretion is the better part of value. Horm Res Paediatr 2018; 90: 146-150.

Samaras TT. We are too tall. Public Health Nutr 2009; 12: 439.

Samaras TT. Is height related to longevity. Life Sci 2003; 7: 1781-802.

Samaras TT. We are too tall (Letter to Editor). Public Health Nutrition 2017;12: 439-440.

Laron Z. The GH-IGF1 axis and longevity. Hormones 2008;7:24-27.

Dardendeliler F, Kargiannis G, Wilton P. Headache, idiopathic intracranial hypertension and slipped capital femoral epiphysis during growth hormone treatment: a safety update from the KIGS database. Horm Res 2007; 68 Suppl 5: 41-7.

Zadik Z. Growth hormone mortality: will history repeat itself? J Pediatr Endocr Met 2012; 25: 813-814.

Sante Adulte GH Enfant (SAGhE): //http// de-croissance-syntetique- somatropinerecombinante-Premiers-resultats-de-l-etude-epidemiologique-sur-la- tolerance-a-long-term-Communique. December 2010.

Carel JC, Ecosse E, Landier F, Meguuellati-Hakkas D, Kaguelidou F et al. Long-term mortality after recombinant growth hormone treatment for isolited growth hormone deficiency or childhood short stature: preliminary report of the French SAGhE study. J Clin Endocrinol Metab 2012; 97: 416-425.

Savendahl L, Maes M, Albertsson-Wikland K, Borgström B, Carel JC, Henrard S et al. Long-term mortality and causes of death in isolated GHD, ISS, and SGA patients treated with recombinant growth hormone during childhood in Belgium, The Netherlands, and Sweden: preliminary report of 3 countries participating in the EU SAGhE study. J Clin Endocrinol Metab 2012; 97: 213-217.

Growth Hormone Research Society; GH Research Society. Consensus guidelines for the diagnosis and treatment of growth hormone (GH) deficiency in childhood and adolescence: summary statement of the GH Research Society. J Clin Endocrinol Metab 2000; 85: 3990-3993.

Fraiser D. Editorial: the treatment of childhood and adolescent growth hormone deficiency-consensus or confusion?J Clin Endocrinol Metab 2000; 85: 3988-3989.

Polak M, Konrad D, Tonnes Pedersen B, Puras G, Snajderova M. Still too little, too late? Ten years ofgrowth hormone therapy baseline data from the NordiNet International Outcome Study. Jpediatr Endocrinol Metab 2018; 31: 521-532.

Saranac L, Zivanovic S, Radovanovic Z, Kostic G, Markovic I, Miljkovic P. Hyperprolactinaemia: different clinical expression in childhood. Horm Res Pediatr 2010; 73; 187-192.

Saranac L, Gucev Z. New insights in septo-optic dysplasia. Prilozi 2014; 35: 123-128.

Saranac Lj, Stamenkovic H, Stankovic T, Zivanovic S, Djuric Z. Growth in Children with Thyroid Dysfunction. In Potlukova E Ed. Current Topics in Hypothyroidism with Focus on Development.Rijeka: InTech 2013: 119-134, available from:

Saranac Lj, Stamenkovic H. Different Faces of Chronic Autoimmune Thyroiditis in Childhood in Adolescence. In Springer D Ed. A New Look at Hypothyroidism. Rijeka: InTech 2012; 125-132, available from:

Saranac L, Bjelakovic B, Djordjevic D, Novak M, Stankovic T. Hypopituitarism occurring in neonatal sepsis. J Pediatr Endocrinol Metab 2012; 25; 847-848.

Saranac L, Stamenkovic H, Radovanovic Z, Kostic G, Bjelakovic B. Microprolactinoma, an unusual cause of growth hormone deficiency in a prepubertal obese boy. Inernat J on Disab and Develop 2005;4: 147-149.

Saranac L, Gucev Z. The ghrelin system; beyond the role in energy homeostasis.Facta Universitatis Series Med and Biol 2016;18: 33-38.

Saranac L, Djuric Z, Stojsic Z, Milenovic A, Lazarevic D. Severe growth failure in a prepubertal boy: what is behind the scene?Austin J Endocrinol Diabetes 2016; 3: 1046-1047.

Saranac L, Djuric Z, Markovic I, Stamenkovic H, Lazarevic D, Cvetkovic V. Outstanding growth response to growth hormone replacement therapy in 3 different cases of growth hormone deficiency.54th Annual ESPE 2015, 01-03 Oct Barcelona: 84.

Saranac L, Bjelakovic B, Zivanovic S, Novak M et al. Pituitary dysfunction types and clinical presentation of pituitary microadenomas in childhood and adolescence. 13th European Congress of Endocrinology, Rotterdam 2011, 30 Apr-04 May; 26.

Saranac L, Novak M, Zivanovic S. Growth hormone deficiency in patients with pituitary lesions. Horm Res 2009; 72: 504.

Scommegna S, Galeazzi D, Picone S, Farinelli E, Agostino R, Bozzao A et al. Neonatal identification for pituitary aplasia, a life-saving diagnosis (review of five cases). Horm Res 2004; 62: 10-16.



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