An auxology-based growth hormone program: update on the Australian experience

In 1988, new guidelines for growth hormone (GH) usage emphasizing auxological criteria were adopted in Australia. Currently, 1,250 children with the following diagnoses are being treated: idiopathic GH deficiency (IGHD), 23.4%; malignancy-related GHD, 7.9%; Turner's syndrome, 12.1%; nonendocrine disorders, 22.2%; idiopathic short stature, 26.0%; endocrine disorders, 3.2%; unknown, 5.3%. At onset of GH therapy, mean age remained lowest in patients with IGHD (8.6 years); mean height SDS was unchanged over time in all groups (-2.8 to -3.3); mean GH doses were lowest for patients with idiopathic and malignancy-related GHD (0.15-0.16 mg/kg/week) and highest for the Turner's syndrome group (0.22 mg/kg/week). Children with GHD demonstrated the best final height outcome (mean final height SDS -1.0 +/- 1.1 for boys and -1.4 +/- 1.2 for girls; improvements of 2.0 SDS for both genders). Mean final height SDS for the other etiologies were similar: -2 in malignancy-related GHD (no improvement), -2.3 in nonendocrine disorders (improvement of 0.7), -1.8 in idiopathic short stature (improvement of 1.1), and -2.3 for Turner's syndrome (improvement of 0.9). In 1993-94, when more stringent entry and exit criteria were introduced, patient numbers and expenditure were halved and have remained unchanged (US dollars 9-10 M per year). The use of auxology-based criteria continues to make possible rational, effective, and economical use of GH therapy in short children in Australia.