DOCTOR’S ORDERS

■ The use of growth hormone for ISS (Idiopathic Short Syndrome) is controversial due to concerns that it might introduce risks to a short but otherwise healthy child.

■ Debate arose in 1985 when synthetic human growth hormone (GH) began to be produced, increasing its supply.

■ In 2003, the US Food and Drug Administration approved GH for children who were not deficient in growth hormone but who were short in stature and slow to grow.

■ The pool of potential candidates for treatment grew to 1 in every 100 children. While girls and boys are equally represented in this group, most who are referred and treated for ISS are boys.

■ Guidelines for paediatric endocrinologists — the doctors who treat short children — say patients should be informed about “the uncertainty regarding long-term safety (post-treatment adverse effects in adulthood).”

■ Weighing the possible long-term risks against uncertain benefits — growth hormone does not work on all children and there is little evidence showing a relationship between height and psychosocial outcomes — makes the field challenging.

■ Tests for GH deficiency are subjective and can be inaccurate, experts note, and may not explain the bigger picture.

■ Some families are interested in GH therapy to give the child a competitive advantage in sports.

■ Genetic research and gene sequencing, while expensive, may help find the causes of ISS and identify who will respond to treatment.

■ Joel Hirschhorn, a professor of genetics at Boston’s Children’s Hospital and leader of GIANT, an international consortium that has uncovered the genes that influence height, said gene sequencing may also reassure parents that “there’s nothing else going on.”