ABSTRACT
Normal pubertal growth and development requires intact gonadotrophic and somatotrophic axes. Puberty is normally associated with about a twofold increase in daily GH production. It is unclear whether this rise represents an epiphenomenon or a real physiological requirement. Children with GH deficiency enter puberty late and fail to achieve a satisfactory pubertal growth spurt. Therefore, it has been advocated, previously, that the GH dose should be increased during puberty to aid this growth spurt and mimic normal physiology. However, there is no convincing evidence of additional benefit from using higher GH doses.168 The lack of further height gain may be attributed to accelerated skeletal maturation and shortened duration of puberty as a consequence of higher GH doses.168
