Short stature and growth hormone therapy. A national study of physician recommendation patterns.
OBJECTIVE
To determine current expert opinion and recommendations regarding the controversial issue of the use of growth hormone (GH) to treat short children who do not have classical GH deficiency (non-GHD children).


METHODS
Analysis of a national survey mailed to 534 US physician experts on the management of short stature (pediatric endocrinologists) with a response rate of 81.3%.


METHODS
The experts' GH treatment recommendations.


RESULTS
The physicians reported that approximately 58% of their current patients undergoing GH therapy have classical GH deficiency, while 42% have other conditions. The proportion of physicians who recommended GH treatment of short non-GHD children ranged from 1% to 74% over all case scenarios presented. The likelihood of GH being recommended depended on the physiological growth characteristics of the child (ie, the child's height, growth rate, and predicted adult height), contingency factors (ie, strong family wishes or a reduction in GH cost), and physician beliefs (ie, the impact of short stature on well-being, the effectiveness of GH therapy). Each of these factors exerted highly significant, independent, and additive effects on decisions to recommend GH.


CONCLUSIONS
Our results indicate that many pediatric endocrinologists consider GH treatment appropriate for selected short non-GHD children, going beyond current Food and Drug Administration-approved indications for GH. Decisions to recommend GH for a non-GHD child rest on a combination of medical, social, and perceptual factors; variations in treatment patterns stem from variations in these influences. Future GH use will likely be determined not only by the results of controlled trials, but also by family preferences, producer pricing, and physician perceptions of the value of height and GH therapy.
Cuttler
L
L
Department of Pediatrics, School of Medicine, Case Western Reserve University, Cleveland, OH 44106, USA.
Silvers
J B
JB
Singh
J
J
Marrero
U
U
Finkelstein
B
B
Tannin
G
G
Neuhauser
D
D
D001290:Attitude; D001827:Body Height; D001828:Body Image; D002648:Child; D003661:Decision Support Techniques; D004363:Drug Utilization / Q000191:economics; D004704:Endocrinology; D006133:Growth Substances / Q000191:economics / Q000627:therapeutic use*; D006262:Health; D006801:Humans; D016015:Logistic Models; D015999:Multivariate Analysis; D018579:Patient Selection; D010372:Pediatrics; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data; D018570:Risk Assessment; D012945:Social Values; D011795:Surveys and Questionnaires; D035501:Uncertainty; D014481:United States
D006133:Growth Substances