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Bryant J, Baxter L, Cave CB, Milne R.
The purpose of this review and meta-analysis was to evaluate the
effects of recombinant human GH on short-term growth and final height in
children with idiopathic short stature (ISS). These children are very short
compared with others of their age for unknown or hereditary reasons. They
are normal size at birth, have normal body proportions, have no evidence of
endocrine deficiency, have no evidence of organic or psychiatric disease and
have normal eating habits. Recombinant human growth hormone has been used to
increase growth and final height in these children.
This review analyzed randomized controlled clinical trials which were
identified from searches of MEDLINE, EMBASE, The Cochrane Library, Science
Citation Index, BIOSIS and Current Controlled Trials. Article reference
lists were searched for trials and experts and pharmaceutical companies were
contacted. The reviewers assessed studies for methodological quality and
extracted data from ten trials that met the selection criteria.
The selected clinical trials included 741 children with idiopathic
short stature and with normal growth hormone secretion. The selected trials
compared administration of growth hormone for a minimum of six months with
administration of a placebo or administration of growth hormone for a
minimum of six months with no treatment. Doses of growth hormone varied from
5mg/ m²/week to 14mg/ m²/week. All of the trials measured short term growth
or final height outcomes. Some of the trials also measured quality of life,
adverse effects and costs.
The trials varied in length from 6 months to 6.2 years and included
between 18 and 121 participants.
Only two of the trails reported final
height outcomes. One trial reported near final height in girls and found
that girls treated with GH were 7.5 cm taller than untreated controls. The
other, which reported adult height standard deviation score found that
children treated with GH were 3.7 cm taller than children in a
placebo-treated group. All of the other trials reported short term outcomes,
measuring either height standard deviation scores or growth velocity.
Results suggest that short-term height gains can range from none to an approximate 0.7 standard deviation over one year. One study reported health related quality of life and showed no significant improvement in GH treated children compared with those in the control group, whilst another found no significant evidence that GH treatment impacts psychological adaptation or self-perception in children with idiopathic short stature. No serious adverse effects of treatment were reported.
The reviewers concluded that growth hormone therapy can increase
short-term growth and improve (near) final height. Increases in height are
such that treated individuals remain relatively short when compared with
peers of normal stature.
