Boosting the Late-Blooming Boy: Use of Growth-Promoting Agents in the Athlete With Constitutional Delay of Growth and Puberty

CONTEXT: The indications for use of growth hormone have broadened with the availability of unlimited recombinant human growth hormone. The Food and Drug Administration’s approval for use of growth hormone in growth hormone–sufficient patients with idiopathic short stature includes some children with constitutional delay of growth and puberty. This is a normal growth pattern variation that includes delayed puberty and prolonged linear growth, usually leading to normal adult height. Use of recombinant human growth hormone to increase growth in short-statured children with constitutional growth delay has been challenged for its modest efficacy in increasing ultimate height, high cost, limited evidence for psychosocial benefit, and some unresolved concerns about long-term posttreatment safety. An additional controversy for the young athlete with constitutional growth delay is the concern for fairness in competition. EVIDENCE ACQUISITION: A PubMed search of the literature from 1957 through May 2010 was conducted. Data sources were limited to peer-reviewed publications. RESULTS: Recombinant human growth hormone is a safe and effective therapy for increasing growth rate in short children with constitutional growth delay, but it does not markedly increase ultimate stature nor confer a clear benefit in athletic performance. CONCLUSIONS: Prescribing physicians should use recombinant human growth hormone treatment responsibly to bring children disabled by short stature into just the normal range.