Approach to the Patient: Safety of Growth Hormone Replacement in Children and Adolescents

J Clin Endocrinol Metab. 2022 Feb 17;107(3):847-861. doi: 10.1210/clinem/dgab746.


The use of recombinant human growth hormone (rhGH) in children and adolescents has expanded since its initial approval to treat patients with severe GH deficiency (GHD) in 1985. rhGH is now approved to treat several conditions associated with poor growth and short stature. Recent studies have raised concerns that treatment during childhood may affect morbidity and mortality in adulthood, with specific controversies over cancer risk and cerebrovascular events. We will review 3 common referrals to a pediatric endocrinology clinic, followed by a summary of short- and long-term effects of rhGH beyond height outcomes. Methods to mitigate risk will be reviewed. Finally, this information will be applied to each clinical case, highlighting differences in counseling and clinical outcomes. rhGH therapy has been used for more than 3 decades. Data are largely reassuring, yet we still have much to learn about pharmaceutical approaches to growth in children and the lifelong effect of treatment.

Keywords: ISS; Noonan syndrome; Prader-Willi syndrome; SGA; Turner syndrome; adverse events; growth hormone deficiency; human growth hormone; neoplasms; safety.

Publication types

  • Case Reports
  • Review

MeSH terms

  • Adolescent
  • Child
  • Counseling
  • Female
  • Growth Disorders / drug therapy*
  • Hormone Replacement Therapy / adverse effects*
  • Hormone Replacement Therapy / methods
  • Human Growth Hormone / administration & dosage
  • Human Growth Hormone / adverse effects*
  • Human Growth Hormone / deficiency
  • Humans
  • Male
  • Recombinant Proteins / administration & dosage
  • Recombinant Proteins / adverse effects
  • Treatment Outcome


  • Recombinant Proteins
  • Human Growth Hormone