Psychosocial Aspects of Short Stature and rhGH Treatment: Implicit Trends over 60+ Years.

Between 1958 and today, advances in research and the clinical management of short stature with GH have occurred. Initially, limited supply of pituitary-derived hGH led to strict criteria for diagnosing GH deficiency and tightly controlled treatment protocols. With the advent of biosynthetic GH, the supply has increased, the number of indications for treatment has grown, and the focus of intervention changed from hormone replacement to treatment of short stature. Improved psychosocial adaptation is an underlying, albeit largely unspoken and inadequately researched, target of treatment. Complicating the ability to make a definitive statement on the effects of rhGH on psychosocial adaptation is the rigor of the psychological outcomes literature. A high risk of bias present in the majority of rhGH treatment studies on psychological outcomes substantially weakens confidence in their results. Studies that convincingly demonstrate, through rigorous research design and methodology, that the benefits of rhGH exceed the risks and burdens are needed.