Tuesday, September 27, 2022

How To Test For Growth Hormone Deficiency

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What is a growth hormone stimulation test?

Side-effects from growth hormone therapy are infrequent and tend to occur when the dose is too high. Fluid retention and discomfort in the joints are reported, but decreasing the dose temporarily can relieve these symptoms. Growth hormone treatment can also increase blood sugar levels. A small number of people can have increased pressure in the brain that can cause headaches and blurred vision. Stopping treatment will resolve this problem.

Taking growth hormone will not cause any increase in height in adults.

Symptoms And Signs Of Growth Hormone Deficiency

Manifestations of growth hormone deficiency depend on the patient’s age, the underlying etiology, and the specific hormone deficiencies.

Growth hormone deficiency itself typically manifests as growth failure, sometimes along with delay in tooth development. Height is below the 3rd percentile, and growth velocity is < 6 cm/year before age 4 years, < 5 cm/year from age 4 to 8 years, and < 4 cm/year before puberty. Although of small stature, a child with hypopituitarism retains normal proportionality between upper and lower body segments. Skeletal maturation, assessed by bone age determination, is > 2 years behind chronologic age.

Other abnormalities may be present, depending on the underlying defect, and the child may have delayed or absent pubertal development. Weight gain may be out of proportion to growth, resulting in relative obesity. Neonates who have congenital defects of the pituitary or hypothalamus may have hypoglycemia , hyperbilirubinemia, midline defects , or micropenis, as well as manifestations of other endocrine deficiencies.

Treatment Of Growth Hormone Deficiency In Children

  • Recombinant GH supplements

  • Sometimes other pituitary hormone replacement

Recombinant GH is indicated for all children with short stature who have documented growth hormone deficiency. Dosing is usually from 0.03 to 0.05 mg/kg subcutaneously once a day. With therapy, height velocity often increases to 10 to 12 cm/year in the first year and, although it increases more slowly thereafter, remains above pretreatment rates. Therapy is continued until an acceptable height is reached or growth rate falls below 2.5 cm/year.

) should be replaced throughout childhood, adolescence, and adulthood when circulating levels of these hormones are low. Diabetes insipidus typically requires lifelong treatment with desmopressin in tablet or intranasal form due to a hypothalamic-pituitary disorder or from resistance of the kidneys… read more ). When puberty fails to occur normally, treatment with gonadal sex steroids is indicated , luteinizing hormone, and follicle-stimulating… read more ).

GH therapy in children with short stature due to therapeutic radiation of the pituitary gland for cancer carries a theoretic risk of causing cancer recurrence. However, studies have not shown a greater-than-expected incidence of new cancers or a greater recurrence rate. GH replacement can probably be safely instituted at least 1 year after the successful completion of anticancer therapy.

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How Is Growth Hormone Deficiency Treated

Since the mid-1980s, synthetic growth hormones have been used with great success to treat children and adults. Before synthetic growth hormones, natural growth hormones from cadavers were used for treatment.

Growth hormone is given by injection, typically into the bodys fatty tissues, such as the back of the arms, thighs, or buttocks. Its most effective as a daily treatment.

Side effects are generally minor, but may include:

  • redness at the injection site
  • hip pain
  • curving of the spine

In rare cases, long-term growth hormone injections may contribute to the development of diabetes, especially in people with a family history of that disease.

Growth Hormone Deficiency: How To Know If You Have It

Growth Hormone Deficiency Test in Adults

Growth hormone deficiency is a health problem which can appear at birth or later on in life. It can affect adults and kids of all ages and has certain health consequences such as short stature in children, decreased muscle mass, low bone density, etc.

This type of deficiency can be caused by various factors, including trauma, infection, radiation, or it could be genetic.

This article takes a closer look at growth hormone deficiency as a medical condition. Keep reading to find out what influences it, how it can be treated, and what are the consequences when it gets too severe.

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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 Adults Can Prepare

Your doctor will typically ask you to take more than one kind of test.

You may need the stimulation test, as well as some of these other tests:

  • The IGF-1 and IGFBP-3 tests, which check the amount of a different but related hormones
  • Tests to check for issues with other hormones, including cortisol, prolactin, and testosterone

Children will also typically get a combination of these tests.

If you need to take a growth hormone stimulation test, you may need to:

Fast: Some medical experts recommend up to 12 hours without food before the test. Talk to your doctor about this beforehand to find out what you should do in your case.

Avoid certain medications: These include insulin, birth control pills, and the herb St. Johnâs wort. If you take these or any other medicines, talk to your doctor to see what you need to do.

Donât exercise: Workouts 10 hours or less before the test can throw off resting hormone levels.

Testing takes up to 3 hours, so you should also dress comfortably and bring a book or some entertainment.

Low blood sugar and obesity may skew results, so talk with your doctor if you have these conditions.

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How Long Does My Child Have To Take The Growth Hormone

You will give your child the growth hormone until he or she has stopped growing. While your child is taking the growth hormone, he or she will need lab tests and doctor visits every 3-6 months. This is to make sure your child is taking the right dose and to make sure there are no side effects. Many children who have growth hormone deficiency do not have it once they are teenagers. When your child has stopped growing, he or she will most likely go off growth hormone for at least one month. Then, we will retest him or her for growth hormone deficiency. If tests show that he or she still has growth hormone deficiency, your child might start taking a lower dose again once he or she is a teenager.

Normal Growth Hormone Levels By Age

Macrilen Stimulation Test for Growth Hormone Deficiency mar3 19

Jennifer Osipoff, MD, a pediatric endocrinologist with Stony Brook Childrens Hospital, says that growth hormone is secreted from the pituitary gland mainly during sleep. Still, this secretion also occurs in small spurts throughout the day.

As such, a random GH level is not a clinically relevant value if assessing for growth hormone deficiency or excess, Osipoff said. Instead, endocrinologists will measure insulin-like growth factor 1 , a protein that is made in response to GH secretion.

Providers break passing levels down into two groups: pediatric patients under 18 and adult patients 18 and over.

Age
acromegaly rare

GHD is rare, and it doesnt usually explain a childs short stature or slow growth. A child may have below-average height for many reasons, including simple genetics.

Slow growth is also common for children, especially right before puberty. Children with a GH deficiency often grow under 2 inches per year.

A healthcare professional may also recommend GH testing if they notice signs a childs body is producing too much GH. For example, this can happen with a rare condition known as gigantism, which causes the long bones, muscles, and organs to grow excessively in childhood.

Adult bodies rely on GH to maintain muscle mass and bone density and regulate metabolism.

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When Is It Ordered

GH stimulation testing is ordered for a child with signs and symptoms of growth hormone deficiency, such as:

  • A growth rate that slows down in early childhood
  • Shorter stature than other children of the same chronological age despite normal or enhanced weight gain
  • Delayed puberty
  • Delayed bone development

Stimulation testing may be ordered for an adult when there are signs and symptoms of growth hormone deficiency and/or hypopituitarism, such as:

Dependence Of Pptp On False Positive Rate

The second example demonstrates that the probability of a positive test being a true-positive test also depends on the false positive rate. This example is for a condition with a prevalence of 50/100,000 persons. It is assumed that all 50 persons with the disease will have a positive result and in the remaining 99,950 people, the rate of false-positive results ranges from 0.0001 to 0.1. Table 2 shows examples of the calculations for Pptp for various false positive rates and Figure 2 shows the graphical representation for the range of false positive rates from 0.00001 to 1.0.

Table 2.

Sample calculations for the dependence of Pptp on false positive rate

Fig. 2.

The general relationship for the dependence of Pptp on the false positive rate. The arrows indicate that for the example where prevalence is 50 cases/100,000 persons, the equal probability that a positive test is either a true positive or a false positive occurs when the false positive rate is approximately 0.0005 . Pptp decreases rapidly at higher false positive rates.

Table 3.

Effect of using multiple tests on the relationship between false-positive and false-negative test results

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Blood Testing For Growth Hormone Levels In Adults

  • Growth Hormone Deficiency in adults can only be diagnosed using specialized blood tests.
  • HGH levels can fluctuate greatly throughout the day, so rather than specifying an exact normal HGH level for adults, doctors speak in terms of a normal range.
  • Instead of a test that measures the HGH level in your blood at any given time, to test for GHD in adults, we use a test called IGF-1.

Growth hormone is essential for normal growth in children. Growth hormone, also known as HGH, also plays a critical role in adults. Growth hormone in adults is responsible for your ability to burn fat and build muscle. It is also essential for immune health, sexual wellness, and many other bodily processes.

Growth hormone does decline as you age. Many men and women over 40 could be suffering from growth hormone deficiency, or GHD. In adults, GHD can lead to tiredness, weight gain, lack of energy and sexual health issues.

The only way to know if you have GHD is to have your growth hormone and preferably your IGF-1 levels tested.

Diagnosis Of Gh Deficiency Without Gh Stimulation Tests

Hormone Health Test: How To Tell If You Have a Hormone Deficiency
  • Struttura Semplice Dipartimentale Endocrinologia Pediatrica e Centro Screening Neonatale, Ospedale Pediatrico Microcitemico A. Cao, Azienda di Rilievo Nazionale ed Alta Specializzazione G. Brotzu, Cagliari, Italy

Growth hormone deficiency is the most commonly affected pituitary hormone in childhood with a prevalence of 1 in 400010000 live births. GH stimulation testing is commonly used in the diagnostic workup of GHD. However, GHD can be diagnosed in some clinical conditions without the need of GHST. The diagnosis of GHD in newborns does not require stimulation testing. Likewise infants/children with delayed growth and/or short stature associated with neuroradiological abnormalities and one or more additional pituitary hormone deficiencies may not need GHST. This review summarizes the current evidence on the diagnosis of GHD without stimulation tests.

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What Are The Complications Of Growth Hormone Deficiency

Left untreated, growth hormone deficiency in children may lead to short stature and delayed puberty.

Despite proper treatment, people with adult-onset growth hormone deficiency have an increased risk of heart disease and stroke. Healthy living, such as eating a balanced diet and participating in routine exercise, can help reduce this risk.

People with adult-onset GHD also have a higher risk of developing osteoporosis. Because of this, they have a higher risk of developing bone fractures from minor injuries or falls. To decrease these risks, its important to have a diet thats rich in calcium and to take vitamin D supplements, as recommended by your healthcare provider.

Popular Clinical Features Of Growth Hormone Deficiency In Adults

Severe cases of growth hormone deficiency in adults are usually associated with obesity, diabetes, a visible loss of muscle mass, and poor sleep quality. At the same time, these patients have increased cholesterol and triglyceride levels as well as hyperglycemia.

Other clinical features popular with people who have growth hormone deficiency include decreased bone density. In fact, these people are more susceptible to have fractured bones, particularly later in life. A study performed on 40 patients with an average age of 44 years revealed that approximately 30% of them developed fractures in the following six years.

Studies have also shown that people with decreased levels of growth hormone can develop an abnormal cardiac function as well as reduced exercise capacity and oxygen volume in the lungs. This means that the heart doesnt work as it should and without treatment, growth hormone deficiency in adults can lead to more serious cardiovascular complications.

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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.

Ask A Laboratory Scientist

Growth Hormone Deficiency and Excess – Med-Surg – Endocrine | Level Up RN

This form enables patients to ask specific questions about lab tests. Your questions will be answered by a laboratory scientist as part of a voluntary service provided by one of our partners, American Society for Clinical Laboratory Science. Please allow 2-3 business days for an email response from one of the volunteers on the Consumer Information Response Team.

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How Can I Help My Child Live With Gh Deficiency

Children who are shorter than their peers may have poor self-esteem or depression. Its important to talk about these problems with your child and your child’s healthcare provider. The provider can recommend counseling or support groups for you and your child.

Talk with your child’s healthcare provider about your child’s potential adult height. Work with your child’s healthcare providers to create an ongoing plan to manage your childs condition.

Parent Information For Crossroads Registration

  • Crossroads Registration is located on the main level near the Crossroads Welcome Desk, between the Crossroads elevators and the Tower elevators. Follow the Blue Path to the Crossroads lobby where the Green Path meets the Blue Path.
  • The Infusion Clinic can be accessed from the Tower elevators . Take the Tower elevators to level 4 and turn right into Suite D.

Parking Options:

  • Hospital Garage on Childrens Drive. Once inside, turn right and follow the Blue Path. It meets the Green Path at the Crossroads Registration Area.
  • Outpatient Care Garage on 18th Street. Enter the hospital and follow the Blue Path. It meets the Green Path at the Crossroads Registration Area.
  • Valet parking on Childrens Drive or 18th Street. Enter the hospital and follow the Blue Path. It meets the Green Path at the Crossroads Registration Area.

If you have any questions, contact your childs health care provider in the endocrinology department.

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How Do We Test For Growth Hormone Levels

Since your growth hormone levels can and do change throughout the day, instead of a test that measures the HGH level in your blood at any given time, we test for the level of IGF-1.

IGF-1 is an endocrine hormone produced by the liver that, along with growth hormone, helps promote normal bone and tissue growth and development. The IGF-1 test is used:

  • To help diagnose growth hormone deficiency
  • To sometimes diagnose growth hormone excess
  • To evaluate pituitary function
  • To monitor the effectiveness of treatment

During the test a blood sample will be drawn from a vein in your arm. Since HGH levels fluctuate throughout the day, we do not test for HGH, but rather IGF-1. IGF-1 mirrors HGH excesses and deficiencies, but the level in the blood is stable throughout the day, making it a more useful indicator of average HGH levels than testing for HGH.

We use LabCorp for all of our hormone tests. LabCorp is one of the worlds most respected life sciences companies and medical testing facilities. You can learn more about IGF-1 and the IGF-1 test by visiting the LabCorp website.

Are There Any Other Ways To Diagnose Growth Hormone Deficiencies

Growth Hormone Deficiency Test in Adults

Rarely, your doctor may choose to do a Clonidine stimulation blood test or a Levodopa stimulation test.

Sometimes, particularly in children, doctors may use some other diagnostic tools, other than a blood test to check for growth hormone deficiency. These could include:

  • Bone density tests
  • X-rays of the bones in the hands or skull for signs of abnormal growth
  • MRIs or other scans of the pituitary

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