Adverse effects
The New England Journal of Medicine published two editorials in 2003 expressing concern about off-label uses of HGH and the proliferation of advertisements for "HGH-Releasing" dietary supplements, and emphasized that there is no evidence that use of HGH in healthy adults or in geriatric patients is safe and effective – and especially emphasized that risks of long-term HGH treatment are unknown. One editorial was by Jeffrey M. Drazen, M.D., the editor-in-chief of the journal; the other one was by Dr. Mary Lee Vance, who provided the NEJMs editorial original, cautious comment on a much cited 1990 study on the use of HGH in geriatric patients with low growth hormone levels.A small but controlled study of GH given to severely ill adults in an intensive care unit setting for the purpose of increasing strength and reducing the muscle wasting of critical illness showed a higher mortality rate for the patients having received GH. The reason is unknown, but GH is now rarely used in ICU patients unless they have severe growth hormone deficiency.GH treatment usually decreases insulin sensitivity, but some studies showed no evidence for increased diabetes incidence in GH-treated adult hypopituitary patients.In past it was believed that GH treatment could increase the cancer risk; a large study recently concluded that "With relatively short follow-up, the overall primary cancer risk in 6840 patients receiving GH as adults was not increased. Elevated SIRs (which is risk of getting cancer) were found for subgroups in the USA cohort defined by age <35 years or childhood onset GH deficiency.
Pediatric endocrinologists were the only physicians interested in the arcana of GH metabolism and childrens growth, but their previously academic arguments took on new practical significance with major financial implications. The major scientific arguments dated back to the days of GH scarcity:
Everyone agrees on the nature and diagnosis of severe GH deficiency, but what are the edges and variations? How should marked constitutional delay be distinguished from partial GH deficiency? To what extent is "normal shortness" a matter of short children naturally making less growth hormone? Can a child make GH in response to a stimulation test but fail to make enough in "daily life" to grow normally? If a stimulation test is used to define deficiency, what GH cutoff should be used to define normal?It was the ethical questions that were new. Is GH not a wise use of finite healthcare resources, or is the physicians primary responsibility to the patient? If GH is given to most extremely short children to make them taller, will the definition of “extremely short” simply rise, negating the expected social benefit? If GH is given to short children whose parents can afford it, will shortness become a permanent mark of lower social origins? More of these issues are outlined in the ethics section. Whole meetings were devoted to these questions; pediatric endocrinology had become a specialty with its own bioethics issues. Despite the price, the 1990s became an era of experimentation to see what else growth hormone could help.