Growth Hormone Deficiency Treatments
Replacing growth hormone to treat GHD involves:
Injection: You inject yourself every day with a small needle. Well help you become comfortable with this.
Side effects: When you first start the medication, you may have muscle or joint aches, and mild swelling from fluid retention. They usually improve after we adjust your dose to the right level for you.
Monitoring: We test your levels and adjust your dose as needed, to control side effects and improve your well-being. Well make sure you dont get too much GH, which can lead to muscle or joint pain, headaches and blurry vision.
Effects of treatment: The goal of GH replacement therapy is to improve your health and reverse GHD features, such as belly fat and low bone density. Many patients see significant benefits from GH replacement. They may gain improved bone density, greater ability to exercise and improved well-being.
Rare Classroom: Adult Growth Hormone Deficiency
Welcome to the Rare Classroom, a new series from Patient Worthy. Rare Classroom is designed for the curious reader who wants to get informed on some of the rarest, most mysterious diseases and conditions. There are thousands of rare diseases out there, but only a very small number of them have viable treatments and regularly make the news. This series is an opportunity to learn the basics about some of the diseases that almost no one hears much about or that we otherwise havent been able to report on very often.
Eyes front and ears open. Class is now in session.
The disease that we will be learning about today is:
Longevity In Ghd In The Syndromes Of Hypopituitarism
Rosén and Bengtsson reported increased cardiovascular mortality in 333 consecutive deaths of Swedish patients with hypopituitarism , which solidified the concept of the detrimental effects of GHD on life expectancy. Nevertheless, a subsequent study of 1014 UK patients with hypopituitarism did not find evidence of association between GHD and increased mortality . In the latter study, independent risk factors for excess mortality were female sex, craniopharyngioma, and untreated gonadotropin deficiency . Importantly, a more recent study with 1286 Swedish patients with hypopituitarism revealed a mildly increased overall mortality . Two important causes of excess mortality were identified: adrenal crisis and an increased risk of a late appearance of de novo malignant brain tumors in patients who previously received radiotherapy. Cardiovascular or cerebrovascular mortality did not significantly exceed those of the reference population . Similarly, cardiovascular mortality was not above that expected in a Danish nationwide study and in another multinational study . Cerebrovascular diseaserelated deaths were modestly elevated in one study , and in women only in another study .
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How Is The Dose Of Growth Hormone Determined
The pediatric endocrinologist calculates the initial dose based on weight and condition being treated. At later visits, the doctor will change the dose for effect and pubertal stage and sometimes based on IGF-1 blood test results. The length of growth hormone treatment depends on how well the childs height responds to growth hormone injections and how puberty affects growth.
How Is Gh Deficiency Diagnosed In A Child
To diagnose GH deficiency, your childs healthcare provider needs to check for other conditions such as:
- Normal variations of growth, such as familial short stature
- Other disorders, such as thyroid hormone deficiency or kidney disease
- Genetic conditions
The healthcare provider will ask about your childs symptoms and health history and about your familys health history. He or she will also give your child a physical exam. Your child’s health and growth may be checked over several months.
Your child may also have tests, such as:
- Blood tests. These are done to check growth hormone and other related hormone levels. Sometimes the blood tests are done after your child is given a substance that would normally raise growth hormone levels.
- X-ray. This test uses a small amount of radiation to make images of tissues inside the body. An X-ray may be done of the left hand and wrist. This can estimate your child’s bone age. With delayed puberty or hormone problems, bone age is often less than calendar age.
- CT scan. This test uses a series of X-rays and a computer to make detailed images of the body. A CT scan can show bones, muscles, fat, and organs. CT scans are more detailed than regular X-rays.
- MRI. This test uses large magnets and a computer to make detailed images of tissues in the body.
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What Can Be Done About Growth Hormone Deficiency
In order to plan the treatment of patients with growth hormone deficiency, a hospital stay is usually necessary. In a specialized clinic, the doctors adjust the therapy individually.
Doctors treat growth hormone deficiency with regular administration of artificial growth hormone . This therapy is usually started as soon as possible after the diagnosis. The hormone must be injected under the skin . Since the amount always has to be exact, the patient and, if necessary, the parents are specially trained in administering the medication.
In children, the treating physicians often end the therapy when the growth in length is complete or there is no longer a growth hormone deficiency. In severe cases it is necessary to inject the growth hormone for life.
In adults, permanent treatment is also necessary in some cases.
In addition, the effect of the artificial growth hormone is sometimes very different from patient to patient. The reason for this is, among other things, genetic differences in the growth hormone receptor .
Doctors now continue treatment with artificial somatotropin even after growth is complete, since the hormone has an effect on many metabolic processes. A positive effect of the treatment on many physical processes in full-grown or adult patients has now been proven.
What Tests Will Be Done To Diagnose Growth Hormone Deficiency
Healthcare providers use different tests to diagnose growth hormone deficiency depending on if youre a child or adult.
GHD diagnostic tests for children
Your childs healthcare provider will review their medical history and growth charts to look for signs of impaired growth, risk factors for growth hormone deficiency and other conditions that can affect growth.
Other health conditions that can affect and prevent growth include:
- Celiac disease.
Since growth hormone levels in your blood normally vary greatly throughout the day, a simple blood test cant determine a GH deficiency. Because of this, your childs provider may order the following tests to help diagnose GHD and/or to rule out other conditions that affect growth:
GHD diagnostic tests for adults
One of the most common tests for diagnosing growth hormone deficiency in adults is the insulin tolerance test. Insulin is a natural hormone your pancreas makes.
During this test, your provider will give you an injection of synthetic insulin to lower your blood sugar level. They will then take blood samples and send them to a lab for testing in order to measure the amount of growth hormone in your blood.
When your body experiences low blood sugar , it normally releases growth hormone. If your blood tests reveal lower-than-normal levels of growth hormone than whats expected for an insulin tolerance test, it confirms growth hormone deficiency.
Other tests may include:
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Does Gh Have A Physiological Role In The Control Of Human Aging And Longevity
In view of the data concerning age-related diseases and mortality in syndromes of GH excess, deficiency, or resistance, it is interesting to ask whether GH might have a physiological role in the control of human aging. Available evidence suggests that, similarly to what was discovered in mice, GH does have an impact on human aging, with its physiological effects on growth, maturation, and metabolism being associated with some costs in terms of healthspan and longevity. However, some of the findings relevant to this issue are surprisingly inconsistent and controversial. This is perhaps best illustrated by a contrast between increased disease risk and mortality of individuals with untreated acromegaly or gigantism and the ability of GH therapy to reverse some age-related changes in body composition of elderly individuals .
The interpretation of longevity data in relationship to GH or GH-dependent traits is further complicated by the evidence that IGF-1, a key mediator of many GH actions, protects from some age-related diseases and pathological changes while increasing the risk of others . Discussion of the role of circulating vs tissue actions of IGF-1 and its binding proteins in the control of aging and in the risk of chronic diseases is outside the scope of this review.
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:
- Infiltrative diseases, such as Langerhans cell histiocytosis, sarcoidosis and tuberculosis.
- Hypothalamus tumors that put pressure on your pituitary gland.
Growth Hormone Deficiency In Adults
In adults with growth hormone deficiency, the moderate general condition and bad mood are in the foreground. Performance and quality of life are often reduced as a result. In addition, a redistribution of fat to the abdomen and trunk is noticeable. Muscle mass and bone density decrease. Blood lipid levels and susceptibility to cardiovascular disease are often elevated. However, growth hormone deficiency in adults may also be largely asymptomatic.
Growth hormone is produced in the pituitary gland. It also produces other hormones. Examples are:
If the growth hormone deficiency is due to a general disease of the pituitary gland, the formation of these other hormones is usually impaired with corresponding symptoms.
Causes And Risk Factors
Growth hormone deficiency is idiopathic in most cases, meaning the cause is unknown. A specific cause can only be determined in around a quarter of cases.
The disease can be congenital or acquired later. Possible causes are, for example, hereditary predisposition, inflammation , vascular damage, injuries, tumors or consequences of radiation exposure . Surgical interventions in the sensitive area of the pituitary gland can also trigger a growth hormone deficiency.
Severe psychological stress sometimes affects the sensitive process of growth and development.
In most cases, the growth hormone deficiency occurs in isolation, which means that there are no other hormone disorders.
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Growth Hormone Excess & Deficiency Treatment
Growth Hormone Excess: Treatment Options
Because excess GH acting alone or together with excess IGF-1 produces adverse health effects, eliminating the hormone imbalance and reducing the levels to normal is desirable. Surgery, medication and/or irradiation of the pituitary gland may be appropriate to achieve these goals.
Surgery. The most common cause of GH hypersecretion is a non-cancerous tumour of the pituitary gland, which produces GH. For these patients, surgery to remove the tumour is usually the treatment of choice and in experienced hands is curative in 50-90% of patients depending on the size of the tumour. If surgery does not normalize the GH level, or if a patient is not a candidate for surgery, other therapies are used. Medication and irradiation of the pituitary gland are options as primary or supplemental therapy.
Medications. Three types of drugs are now available for the treatment of GH excess somatostatin analogues, GH receptor antagonists, and dopamine agonists. These medications do not cure the disorder but work, instead, to reduce levels of GH or IGF-1. These medications must be taken for life if surgery or irradiation fails to eliminate the cause of GH excess.
Growth Hormone Deficiency : Treatment
What Are The Different Kinds Of Growth Hormone Deficiency
There are three main types of growth hormone deficiency , including:
- Congenital GHD: Congenital GHD means its present from birth due to a genetic mutation or structural issues in the babys brain.
- Acquired GHD: GHD is considered to be acquired if its onset is later in life as a result of damage to your pituitary gland. Children and adults can have acquired GHD.
- Idiopathic GHD: In the medical world, idiopathic means theres no known cause. Some cases of GHD have an unknown cause.
Growth hormone deficiency is also categorized by the age of onset. It has different symptoms and processes for diagnosis if youre a child or adult when the condition begins.
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Blood Test To Measure Other Hormone Levels
IGF-1 is a hormone made by the liver in response to growth hormone. The level of IGF-1 may be low in growth hormone deficiency but can also be normal. It is therefore not a sensitive marker of GH deficiency on its own.
To check how well the rest of the pituitary gland is working, other hormones are measured. This includes cortisol, thyroid hormone , sex hormones and prolactin. This involves collecting a small amount of blood and sending it to a laboratory for tests.
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 .
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Who Gets Growth Hormone Deficiency
Incidence: Growth hormone deficiency is relatively rare. About one in 4,000 to 6,000 children have GHD, and it affects about 50,000 U.S. adults.
Sex: GHD, except for one inherited subtype, affects boys and girls equally, though data shows boys are more likely to be diagnosed and treated.
Race/ethnicity: Scientists are not aware of differences across racial or ethnic groups, though data suggests that white people are more likely to be diagnosed and treated.
Risk factors: A family history of GHD or having had brain surgery or radiation therapy to the head can increase risk of GHD.
Auxological Outcomes Of Early Gh Treatment
In the past, reports have suggested that early diagnosis and treatment of GHD patients lead to a greater improvement in height gained, even if the final height remained near 2 SD below the mean population . However, in 1995, Boersma et al. evaluated 26 children who had started GH treatment before the age of 3 years and reported that early treatment of GHD may to lead to adequate catch-up growth, stressing that the early diagnosis and treatment before the statural impairment became evident was essential . In the same paper, Boersma et al. reported how height SDS correlated positively with injection frequency and height SD score at start of treatment, noting that past treatment regimens, for example, 2 or 4 injections per week, could be responsible for failure to complete height gain . In contrast, in children treated with 6 or 7 injections per week, the initial height at the start of treatment was reported to be crucial, since those with an initial height SDS between 2 and 4 showed a remarkable catch-up growth, whereas children with an initial height SDS < 4 did not reach full catch-up growth, although the study follow-up was only 4 years .
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Questions To Ask Your Doctor
You and your family are key players in your childs medical care. Its important that you share your observations and ideas with your childs health care provider and that you understand your providers recommendations.
If your child is experiencing symptoms of growth hormone deficiency and youve set up an appointment, you probably already have some ideas and questions on your mind. But at the appointment, it can be easy to forget the questions you wanted to ask. Its often helpful to jot them down ahead of time so that you can leave the appointment feeling like you have the information you need.
If your child is old enough, you may want to suggest that she write down what she wants to ask her health care provider, too.
Some of the questions you may want to ask include:
- Whats causing my childs growth hormone deficiency?
- Will you be prescribing growth hormone replacement therapy?
- Are there any side effects or potentially dangerous risks to treatment?
- How long will my child have to remain on medication?
- How much can I expect my child to grow?
What Causes Childhood
A child can be born with this defect or acquire it later on in life .
Congenital growth hormone deficiency , can be due to defects in some of the genes involved with the production or the action of growth hormone or due to abnormalities in the structure of the brain . It can be also associated other abnormalities such as facial malformations or as part of a syndrome. Sometimes, the cause is not apparent, this is called idiopathic.
A child, similarly to an adult, can also acquire growth hormone deficiency as a result of a brain tumour and its treatment, brain injury, infection or inflammation. See articles on hypopituitarism and adult-onset growth hormone deficiency for more information.