| Popis: |
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%; nonendogrine 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$ 9-10M 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. |
