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Fifty-nine tall girls were treated with oestrogen to reduce final height, starting at the ages of 9.1 to 16.2 years. We assessed the result of this treatment by comparison with matched controls. The epiphyseal bone age at the start of therapy, the final height, the Bayley-Pinneau (BP) and Roche-Wainer-Thissen (RWT) predictions of final height, and the errors in both predictions were evaluated. The matched pairs were divided into three groups according to bone age at the start of treatment; I less than 10.5 (n = 16), II 10.5-12.0 (n = 22) and III greater than 12.0 years (n = 21). The mean (SD) intrapair reduction of height for these groups was 9.7 (4.0) cm, 4.3 (4.3) cm and 3.5 (3.2) cm, respectively, according to BP predictions and 6.3 (4.3) cm, 3.4 (3.0) cm and 1.2 (3.3) cm according to RWT predictions. No method of predicting height is accurate for tall girls and simultaneous predictions may differ greatly. Close agreement between the BP and RWT predictions does not indicate greater accuracy. The earlier therapy is started, the greater is the effect. Young girls need psychosocial support with therapy.

These baseline data confirm that many children with significantly short stature are vulnerable to diverse developmental, social and educational problems, and substantiate the importance of a multidisciplinary treatment approach that includes a comprehensive psychological and medical assessment. The psychological assessment should focus on the early detection of problems in academic achievement and psychosocial development, in order that appropriate educational and counselling interventions can be provided. The paediatrician can also foster a positive relationship with patients and their families to facilitate treatment compliance and improve overall outcome in several ways. These include a simple explanation of the aetiology of the child's short stature and how the diagnosis was made, a review of the treatment protocol that includes information about potential side-effects and suggestions for minimizing conflicts about injections, and an open discussion of prognosis to help families develop realistic expectations. It is further suggested that paediatricians stress that treatment outcome should be assessed in psychological terms, such as increased responsibility, as well as physical growth. These anticipatory interventions will help to ensure that the eventual outcome of comprehensive treatment is an optimally functioning young adult.

A cohort study was carried out to determine whether childrens' perception of the problem of short stature changed over 2 years of growth hormone (GH) therapy. A total of 66 children (age range, 5-15 years; mean 10.2 years) were selected on the basis of height below the 3rd centile for chronological age, height velocity below the 25th centile for bone age, prepubertal status, and absence of any organic condition causing growth failure or likely to interfere with GH action. The children were taking part in a 2-year multicentre trial to assess the effect of authentic recombinant GH on short, slowly growing children without GH deficiency (GHD). The childrens' and parents' attitudes and emotional adjustment to shortness were assessed before GH therapy commenced, and at 6 months and 2 years, using a growth-specific psychological instrument, the Attitude to Growth scale (ATG). The children were also assessed using the Piers Harris Childrens Self Concept Scale at 2 years. The mean ATG scores increased from 34.2 (95% confidence interval, 33.2-35.2) at intake to 37.2 (95% confidence interval, 36.2-38.2) at 2 years. Younger subjects had a greater increase (p less than 0.05). No sex differences occurred. Two separate factors were identified in the childrens' attitudes: emotional preoccupation with stature and a concrete focus on practical aspects. No differences were present between childrens' and parents' mean scores, though parents' estimates differed on selected items. The mean Piers Harris score at 2 years was within the normal range, and was positively correlated to the ATG but was unrelated to height. It is concluded that GH treatment may have a beneficial effect on childrens' attitudes to being short, particularly in the younger child.(ABSTRACT TRUNCATED AT 250 WORDS)

The effects of a 12-week period of substitution therapy with somatrem have been investigated in six adults with confirmed hGH deficiency. Five of the six patients experienced a subjective improvement, mentally and physically, but these improvements were not demonstrated when the patients were assessed objectively. No side-effects were reported. Serum procollagen III peptide increased in all patients and serum IGF-1 increased in five of the six patients.

This paper describes a multidisciplinary approach to treating patients with hGH deficiency. The team includes paediatric endocrinologists, social workers and psychologists, and is felt to provide a much better standard of care, producing subjects who are well integrated into society.