Growth Hormone Deficiency
Vijayakumar Madhava
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Growth Hormone Deficiency - Treatment
Treatment option available for growth hormone deficiency is recombinant human growth hormone. Normalization of height in a child with GH deficiency is the primary objective of the treatment. Normally growing children with craniopharyngioma should also be considered for GH therapy. Daily depot preparations are commonly in use at present.
Dosing: GH is administered as subcutaneous injection in the evening. It is commonly used in the range of 25- 50 µg/kg/day (1 mg = 3 IU). Higher dose may be required in special conditions (Turner’s syndrome)

Monitoring: After initiating the treatment, the patient should be followed up at regular intervals. He should be recalled after a week of initiation of therapy to look for any adverse effects of injections. There after regular monitoring should be done once in 4-6 months. Most important parameter for assessing the response to treatment is the demonstration of increase in height and height velocity, plotted in a growth chart. Serial assessment of serum IGF-1 and IGF-BP3 levels are done but they do not always correlate well with the growth response. Yearly monitoring of thyroid hormone status (free T4 and TSH) and adrenal status (morning serum cortisol) as well as bone age estimation is a must.

Factors affecting the response: Younger the age of initiation of treatment, greater will be the response. If the child is entering the puberty with an unsatisfactory height, GH dose escalation or combined GH and GnRH agonist therapy is tried.

Multiple pituitary hormone deficiency (MPHD): in these children, in addition to GH therapy, monitoring of other pituitary hormonal deficiencies should be done regularly since they may manifest at a later age. If detected, supplementation (thyroxine, hydrocortisone, sex steroids, DDAVP) should be carried out.

Transition to adult management: GHD may persists into adult life. Other than promoting linear growth, GH has important metabolic actions which are important for maintaining adult body compositions and health. After the final height is achieved, as suggested by closed sutures in a hand x-ray and other parameters, a retesting of GH- IGF axis is done by doing a GH stimulation tests after stopping GH therapy for 3 months. Measurements of other pituitary hormones, IGF-1, and in selected cases, insulin tolerance tests, bone mineral density, fasting lipid levels also should be done. Continuation of growth hormone treatment is advocated if adult GH deficiency is diagnosed.

Conclusion: Growth hormone deficiency is not a rare disease. Since recombinant human growth hormone is available, even though costly, treatment is a reality and the response is excellent once the treatment is initiated sufficiently early. Only way to identify this disease sufficiently early is to have his /her growth standards plotted in a growth chart.


Figure 1: A case of growth hormone deficiency, diagnosed at age of 8 year. Note the typical “Doll like face” with prominent forehead, protruding eyes, and mid facial hypoplasia


Figure 2: Same girl after treatment for 2 years ( at the age of 10 years)


Figure 3: After treatment for 5years (at age 13 years of age)



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