Children with idiopathic short stature, have to be treated with growth hormone?

Idiopathic short stature, or short stature of undefined cause, is a diagnosis of exclusion. Implicit in the diagnosis is a normal growth hormone responses to stimulation testing- In 2003, the FDA approved the use of recombinant growth hormone (GH) for treatment of idiopathic short stature, defined by height SDs < 2.25 and adult height prognosis bellow the normal range. Considerable debate exits about the benefits of therapy in otherwise healthy short children. Studies suggest that growth hormone therapy increases adult height between 3 and 6 cm, with a mean duration of therapy (regimen of daily injections) of about 6 years. In addition, the studies have failed to prove that children with short stature have psychosocial problems; moreover growth hormone therapy has not showed to improve quality of life. Concern exists about potentially long-term adverse effects with administration of supraphysiologic GH doses apart from its high cost. At the core of controversy is the question about whether short stature is a disease or a normal variant development and therefore whether growth hormone therapy is a therapeutic or a cosmetic intervention.