The use of growth hormone (GH) has progressively moved from a substitution therapy to a pharmacological agent promoting growth when it is otherwise considered insufficient. This process has progressed stepwise from conditions with definite diagnoses such as Turner syndrome towards children born small for gestational age (SGA) and more recently those with idiopathic short stature. Unsurprisingly, no set European or national perspective can be presented given the multiple points of view that must be taken into account when considering these treatments. In France, the use of GH has been approved for use in SGA children since 1995 and has been covered by the national insurance system since 1997. National data regarding the use of GH for this indication will be presented, in particular with regard to the recommendations for use made by the national insurance system. In 2003, after a complex procedure lasting more than 2 years, two GH preparations, including Norditropin®, were approved at European level for use in SGA children. Based on the data presented, the European Medicines Evaluation Agency approved a dose of 35 µg/kg per day, which is that generally used in GH deficiency. This is paradoxical, given that GH-deficient children are generally considered to be more sensitive to treatment than their non-GH-deficient counterparts. It is of interest that the influence of GH dose on outcome has only been demonstrated in the first years of treatment and not in any long-term, near-adult-height analyses. Thus the ‘European perspective’ emphasizes long-term results rather than short-term catch-up. By contrast, in the USA a higher dose is recommended, emphasizing on short-term gain. Other differences concern the minimum age at the start of treatment and the minimum height deficit before chronic treatment can be instituted.

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