As more data accumulate on the GH treatment of SGA children, the interesting question of their insulin sensitivity, or lack thereof, has been addressed. Cutfield and co-workers reported on a group of young SGA children looking at diminished insulin sensitivity with GH treatment. This current study reports similar data in group of older prepubertal and pubertal children. The growth responses to GH are good and do not appear to be adversely affected by the worsened insulin sensitivity. The study does show that varied methods of simply working about insulin sensitivity generally correlate but certainly do not give similar answers in individual children. The interesting finding here and in the Cutfield group is that the insulin resistance is occurring in a thin cohort of post-SGA children both prior to and more so after GH treatment. This would affirm the notion that the finding of insulin resistance in the overweight, more generously growing post-SGA children is clearly also seen in those who are thin. The authors are concerned about their finding and recommend against treating SGA children close to or during puberty. While it is well-described that better growth responses are seen in younger children (as in most GH treatment scenarios), I would not think that the data regarding the development of insulin resistance are sufficiently adverse to negate late treatment. The reversibility of the insulin resistance has been described so it would seem that longer term follow-up studies are needed to look more carefully at this question of late treatment with GH. Edward O. Reiter.