Themes Generated By Focus Groups
The analysis identified five domains of impact: Psychological Health, Physical Health, Cognition, Energy Loss, and Treatment Effects. Total saturation of themes was reached after the sixth focus group. When considered by domain, saturation was reached after the second focus group for themes related to physical health and cognition, and by the third focus group for themes related to daily life impacts due to energy loss. Saturation was reached by the sixth focus group for themes related to psychological health and treatment effects.
Signs And Symptoms Of Growth Hormone Deficiency
A noticeable slowing of growth is one of the most obvious signs of GH deficiency in children. A GH deficient child usually grows less than 2 inches per year. Children with GH deficiency are smaller and tend to look younger than their peers, but they usually have normal body proportions.
Adults who have GH deficiency may have a variety of different physical symptoms, such as thinning of the bones, decreased muscle strength, increased body fat, or high blood cholesterol levels. Adults may also have emotional symptoms such as feeling tired, anxious, irritable, pessimistic, or unmotivated.
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What Is The Prognosis For Growth Hormone Deficiency
For children with growth hormone deficiency , the earlier the condition is treated, the better the chance that a child will grow to near-normal adult height. Many children gain four or more inches during the first year of treatment and three or more inches during the next two years of treatment. The rate of growth then slowly decreases.
People with adult-onset GHD generally have a good prognosis and can lead a healthy life if GHD is treated properly.
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Does Growth Hormone Deficiency Shorten Life Expectancy
If you look at the above list of symptoms, they can all have a severe impact on the quality of your life, yet none of them appear to be fatal. That is true, and generally speaking, having a growth hormone deficiency does not necessarily mean you are at greater risk of dying young, particularly if you obtain treatment for GHD.
But, lets take another look at those known negative impacts of growth hormone deficiency in adults. One of the main negative effects of low levels of human growth hormone is on body composition. Lack of HGH inhibits your ability to build muscle. It also slows your metabolism, so that you cannot burn fat as efficiently. Those two impacts alone, can, and often do, lead to obesity. Obesity, along with some of the other problems of adult GHD, can lead to metabolic syndrome, which is a combination of disorders that together can increase your risk of cardiovascular disease, diabetes, and liver disease. Cardiovascular disease, diabetes and the other conditions that can result from metabolic syndrome, certainly can shorten your lifespan. Therefore, in this respect, untreated growth hormone deficiency in adults, can contribute to increased risk of mortality. However, the good news is, that GHD in adults is treatable, and proper treatment for growth hormone deficiency can not only decrease you risk of cardiovascular disease, it may even help you to live longer!
Growth Hormone Deficiency In Adults Life Expectancy
According to Johns Hopkins Medicine news and publications, growth hormone deficiency has no significant impact on the life expectancy of an individual. The publication goes on to reveal that people with GHD due to genetic mutations will live just as long as people who produce normal amounts of the hormone.
The only factors that shortens the life span of people with GHD are the secondary effects of GHD such as cardiovascular disease.
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Growth Hormone Deficiency Disease
Growth hormone deficiency disease refers to the classic clinical presentations that accompany lack of or insufficient production of growth hormone. It is often associated with inadequate production of other pituitary hormones. In such a situation where other pituitary hormones are inadequately produced, the condition is referred to as combined pituitary hormone deficiency.
However, when growth hormone deficiency is not accompanied by any other hormonal deficiency, the condition is called, isolated growth hormone deficiency.
Isolated growth hormone deficiency
Just as the name suggests, isolated growth hormone deficiency is a condition where there is severe shortage or absence of growth hormone, though, without any other hormonal problem. Like other cases of growth hormone deficiency, people with isolated growth hormone deficiency have an unusually short stature due to failure to grow at the expected rate.
Complete absence of growth hormone is classified as Type 1A isolated growth hormone deficiency. In more ways than one, this is the most severe form of the deficiency disease out of all the four types. The classic presentation of this disease is very evident at birth because the affected babies are usually shorter than expected when they are born.
What is Partial growth hormone deficiency?
What is Idiopathic growth hormone deficiency?
What is Pediatric growth hormone deficiency?
Genetic Counseling For Dwarfism Risk
If you have dwarfism and are considering having a baby, genetic counseling may be helpful. For example, if you and your partner both have achondroplasia, your potential child would face the following odds:
25% chance of not having achondroplasia
50% chance of having achondroplasia similar to what you have
- 25% chance of having a double mutation of the achondroplasia gene mutation, which likely would cause your baby to die at birth or shortly thereafter
A genetic counselor can help you figure out your best reproductive options. Your primary care doctor can help you identify what has caused your dwarfism and can refer you for genetic tests and counseling, if needed.
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Assessment Of Patient Characteristics
All the patients had a full history taken and a physical examination, and were receiving standard hormone replacement therapy for any combination of secondary adrenal, gonadal and thyroid failure as well as diabetes insipidus. For all patients the age of onset of the pituitary disorder and details about the diagnosis of GHD were noted on enrolment into KIMS, and the following variables recorded: age, body weight, body mass index , waist:hip ratio, duration of GH therapy, number of additional pituitary hormone deficiencies and serum levels of insulin-like growth factor I , total cholesterol, high-density lipoprotein -cholesterol, low-density lipoprotein -cholesterol and triglycerides. The IGF-I and lipid profiles were analysed centrally. Serum concentrations of IGF-I were determined by radioimmunoassay after separation of IGFs from IGF-binding proteins by acidethanol extraction and with des-IGF-I as radio-ligand, to minimize interference of IGFBPs in the extract. The intra- and interassay coefficients of variation were 10% and 3.1% respectively. The normal range in the IGF-I assay was adjusted for age and is expressed as IGF-I standard deviation scores . The GH concentrations were determined by different methods in each hospital.
QoL was assessed using the disease-specific QoL Assessment of GHD in Adults questionnaire before treatment and after 1 and 2 years of treatment with GH.
About Gh Test Results
Our experienced medical doctors will interpret your results according to the specific provocation test used as well as other factors that may affect the accuracy of your results.
The main factors potentially affecting the accuracy of the test may include your body weight and insulin sensitivity. These will be accounted for either by increasing the dose of the medication or adjusting the cut-off value.
The cut-off point which indicates GHD during the ITT is HGH levels remaining under 5.1 ng/ml. For the GST, the cut-off values are HGH levels under 3.1 ng/ml in patients with normal weight and insulin sensitivity while HGH< 1.1 ng/ml indicates GHD in patients with obesity. For the Macimorelin test, HGH levels under 2.9 ng/ml indicate GHD.
Normal ranges for GH levels in men are between 0.01-2.47 ng/mL, and in women 0.13-9.88 ng/mL. While peak GH levels in adults can be around 5 ng/mL in men and 10 ng/ml in women.
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Growth Hormone And Genes Related To Gh Signaling Are Involved In The Control Of Human Aging
The negative association of somatotropic signaling with longevity discovered in laboratory rodents applies to other mammalian species, apparently including humans. Thus, exceptional longevity in humans has been associated with reduced IGF-1 levels and insulin/IGF-1 composite signaling score . In many populations, shorter people live longer , and offspring of long-lived families secrete less GH than their spouses . Moreover, mortality is increased in individuals with pathologic excess of GH . Studies of the genetic polymorphism of candidate genes, genome-wide association studies , and analysis of signaling pathways, genetic networks, and copy number variations, provided evidence that human aging is influenced by genes related to the somatotropic axis and its downstream targets including FOXO3A .
Surprisingly, mutations leading to profound suppression of GH secretion or to GH resistance have no major or consistent effect on human longevity , as was mentioned earlier in this article. However, they can provide protection from aging-related diseases including cancer, diabetes, and atherosclerosis , in spite of changes in body composition and serum lipids that could be described as unfavorable. There is also intriguing evidence that severe genetic GH deficiency can reduce age-related changes in muscle function, cognition, and behavior leading to extension of the healthspan and healthy aging .
What Causes Growth Hormone Deficiency In Adults
Adult-onset GHD can be caused by damage to the pituitary gland resulting from the following:
- Severe head injury
- Radiotherapy directed at the brain
- Pituitary apoplexy, or a sudden hemorrhage in the pituitary gland
- Interference in blood supply to the pituitary gland
GHD in adults can also come from genetic abnormalities present since birth.
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When Should I See My Healthcare Provider About Growth Hormone Deficiency
There are many reasons for slow growth and below-average height in children. At times, slow growth is normal and temporary, such as right before puberty starts. If youre concerned about your childs rate of growth, see a pediatric endocrinologist or healthcare provider. They can help find out if your childs rate of growth is cause for concern.
If youre an adult and are experiencing symptoms of growth hormone deficiency , talk to your healthcare provider.
If you or your child have been diagnosed with GHD, youll need to see your healthcare provider regularly to make sure your treatment is working properly.
A note from Cleveland Clinic
If youre noticing a lack of growth in your child, its important to talk to their healthcare provider as soon as possible. While it may be unlikely that growth hormone deficiency is the cause, any concerning changes are worth evaluating. People with GHD who are diagnosed early have the best outlook and usually lead healthy lives. If you have any questions about what to expect with your childs growth, dont be afraid to reach out to their provider. Theyre there to help.
Last reviewed by a Cleveland Clinic medical professional on 06/21/2022.
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How Is Growth Hormone Deficiency Diagnosed
Diagnosis of growth hormone deficiency in children most often occurs during two age ranges. The first is around 5 years of age when children begin school. This is because parents can more easily see how their childs height compares to the height of their classmates. The second age range is around 10 to 13 years old in children assigned female at birth and 12 to 16 years in children assigned male at birth, which are the age ranges when puberty typically starts. A delay in puberty can signal suspicion of GHD.
Growth increments are the most important criteria in the diagnosis of GHD in children. Normal levels of growth usually follow a pattern, and if growth during a recorded six- to twelve-month period is within those ranges, its unlikely that they have a growth condition.
Adult-onset growth hormone deficiency is often difficult to detect because the symptoms are subtle and commonplace. This makes it more difficult to diagnose.
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Aging And Longevity Reflect Impact Of Environmental And Genetic Factors
Until fairly recently, it was assumed that the genetic control of longevity, like other quantitative traits, is polygenic with numerous genes exerting relatively small, additive, synergistic, antagonistic, or protective effects. However, results obtained in the 1980s in a round worm, Caenorhabditis elegans, challenged this view by showing that mutation of a single gene can produce impressive extension of longevity . Since then, numerous life-extending mutations have been identified in different animal species and their actions were related to specific signaling pathways within the cells. It is the purpose of this article to review what has been learned about the endocrine control of aging in mammals from studying life extending mutations. We will focus on the impact of genes related to the somatotropic axis, which consists of the hypothalamic growth hormone releasing hormone , the hypophyseal growth hormone , and insulin-like growth factor 1 on aging and longevity.
What Causes Growth Hormone Deficiency
The causes of growth hormone deficiency can vary based on what age you are at the onset of the condition. Some cases of GHD are considered idiopathic, meaning the cause of the condition cant be determined.
Causes of congenital growth hormone deficiency
Congenital growth hormone deficiency results from a genetic mutation and may be associated with brain structure issues or with midline facial abnormalities, such as a cleft palate or single central incisor.
Scientists have identified several genetic mutations that cause GHD, including:
Isolated growth hormone deficiency can have different inheritance patterns depending on the type of the condition.
Causes of acquired growth hormone deficiency
Cases of acquired growth hormone deficiency result from damage to your pituitary gland that affects its ability to produce and release growth hormone. Children and adults can develop acquired GHD.
Pituitary damage can result from the following conditions or situations:
- Severe head injury or traumatic brain injury .
- A lack of blood flow to your pituitary gland.
- Accidental or unpreventable damage from brain surgery or surgery to remove a pituitary adenoma.
- Infiltrative diseases, such as Langerhans cell histiocytosis, sarcoidosis and tuberculosis.
- Hypothalamus tumors that put pressure on your pituitary gland.
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What Is Growth Hormone Deficiency
Growth hormone deficiency is a condition wherein the pituitary gland fails to produce enough growth hormones. While this is a condition common in children, adults can acquire this later in life as well.
GHD occurring later in life is also called adult-onset growth hormone deficiency.
What is the pituitary gland? Its a small, pea-sized gland at the base of the skull. It secretes hormones that regulate body temperature and thyroid activity.
Growth Hormone Deficiency Guidelines
The following guidelines are the recommendation when managing and/or treating growth hormone deficiency in adult patients:
- Patients who should be evaluated for acquired form of growth hormone deficiency are those who have undergone surgery or chemotherapy in the head and neck as well as those with structural hypothalamic/pituitary disease. Patients with an evident pituitary hormone deficiency are also included in this category.
- Idiopathic GHD is very rare in adults. As a result, stringent guidelines have been put in place before you conclude a diagnosis of this condition. This is because the diagnostic test results that reveal an idiopathic GHD are usually false positive results.
- The presence of deficiencies in three or more axes of the pituitary are strongly suggestive of a GHD. In this circumstance, testing is always optional.
- During treatment with GH, patients are supposed tobe monitored in 1 to 2 month intervals. During such monitoring, clinical assessments and evaluation of adverse effects are made to find out how the patient is responding to treatment.
These are not the only guidelines for growth hormone deficiency disease, but they are among the most common. They help ensure that GHD is adequately diagnosed and treated.
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Growth Hormone Deficiency Medications And Treatment
Children and some adults with growth hormone deficiency will benefit from growth hormone therapy. The goals of treatment are to increase growth in children and restore energy, metabolism, and body composition. The doctor may prescribe growth hormone, also called somatropin . The drug is given as shots a few times a week that is injected underneath the fat of the patientâs skin.
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How To Find Growth Hormone Therapy
Growth hormone deficiency is when the body does not produce enough of this crucial hormone. This can cause people to lose muscle mass and height, have an increased risk of cancers, heart disease, and diabetes, as well as sleep apnea. Growth hormone therapy can help prevent these problems by giving the body what it needs.
The most common growth hormone therapy is long-acting recombinant human GH . This is a life-long treatment that can be given once a week. It is given in the form of a shot or through an IV. Another option to consider is GH injections. The thyroid gland secretes thyroid hormones. When thyroid hormone levels are high, the body releases more energy and higher performance.
This can be detected through a blood test that checks for an elevated TSH level. When these levels drop, they cause depression, fatigue, weight loss, and muscle weakness. Some with hypothyroidism may experience excessive sweating and heat intolerance. Thyroxin therapy is one treatment option for those who suffer from hypothyroidism.
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The Negative Impact Of Somatotropic Signaling On Longevity Discovered In Mutant Mice Applies To Mice That Have Not Been Genetically Modified As Well As Other Species
As indicated in the introduction to this review, the current interest in the role of GH in the control of aging stems primarily from the reports of remarkable extension of longevity in mice with GHD or resistance due to spontaneous mutations or targeted deletions of genes related to GH biosynthesis, secretion, and/or actions . Importantly, blocking GH signaling in these animals not only extends lifespan, but also healthspan, and it slows the rate of aging . The evidence for slowing the rate of aging is of particular significance, as it indicates that extension of longevity in these mutants is not due simply to reduced IGF levels protecting them from cancer, which is the leading cause of death in most strains of laboratory mice. The findings of reduced longevity in transgenic mice with gross, supraphysiological elevation of circulating GH levels are also robust, reproducible, and based on observations in different independently produced lines of animals and in different laboratories .