Since the 1970s, growth hormone (GH) treatment has been an important tool in paediatric endocrinology in the management of dwarfism in children. We were of course always aware of physiological effects of GH other than growth. However, efforts focused mainly on the effect of GH on skeletal growth. In addition, the GH material, available for treatment or experimentation, was from human sources and therefore scarce and expensive. Thus, despite the fact that many of our GH-treated patients suffered from both psychosocial and physical strain when they reached adulthood, GH treatment in adults was never an issue until biosynthetic GH became available in large quantities in the mid-1980s.
Recent progress has provided sufficient basis to make GH treatment of adults an important issue for endocrinology. The following chapters contain a wealth of information documenting this. In my opinion, the principle of GH substitution in individuals with GH deficiency, including adults, is sound. In other areas of endocrinology we do not hesitate to substitute a missing hormone with important physiological actions. It can be argued of course, that administration of other hormones as for example thyroid hormones, adrenal steroids and androgens, is simpler and much cheaper. However, we should remember that although biosynthetic GH is a new and expensive drug, the price of it must come down, as both its use and the competition between the manufacturers increase.
Despite this there are still those who are sceptical concerning the use of GH in the management of adults with GH deficiency. My advice would be to read this book. To me the question is not if we should treat, but to whom and how the treatment should be given.
