What Are The Risk Factors For Growth Hormone Deficiency
Unfortunately, most cases of growth hormone deficiency arent preventable. Certain risk factors can increase you or your childs likelihood of developing acquired GHD, including:
- Cancer treatment before reaching adult height.
- Radiation to your head or brain.
- Total body irradiation.
- Surgery to your brain, especially the central region of your brain where your pituitary gland is located.
If any of these risk factors apply to you or your child, its important to talk to your healthcare provider about the signs and symptoms of GHD to look out for.
What Is A Human Growth Hormone Deficiency
What is a human growth hormone deficiency? When a mans or womans vital growth hormones are not at the level that they should be within the blood stream, this is called a growth hormone deficiency. The only way to test for a GH deficiency is through a blood test.
Different clinics have varying ranges of what they deem to be low, normal and high levels of growth hormone in the system. However, there is an average number that most people will fit into on those ranges. One should not be too alerted if they fall out of the range on one chart because they may have normal growth hormone levels on another chart.
A true growth hormone deficiency is when ones numbers are extremely low and symptoms are consistent with their low blood test results. The good news about a GH deficiency is that it is nothing abnormal. Most people go through the experience of having a growth hormone depletion. There is solid, research based, effective and safe treatment that can help raise the hormone levels, reduce or eliminate symptoms and give a person back their great quality of life.
Definition Of Gh Deficiency In Adults
1.1 We recommend that patients with childhood-onset GHD who are candidates for GH therapy after adult height achievement be retested for GHD unless they have known mutations, embryopathic lesions causing multiple hormone deficits, or irreversible structural lesions/damage .
1.2 We recommend that adult patients with structural hypothalamic/pituitary disease, surgery or irradiation in these areas, head trauma, or evidence of other pituitary hormone deficiencies be considered for evaluation for acquired GHD .
1.3 Idiopathic GHD in adults is very rare, and stringent criteria are necessary to make this diagnosis. Because in the absence of suggestive clinical circumstances there is a significant false-positive error rate in the response to a single GH stimulation test, we suggest the use of two tests before making this diagnosis. The presence of a low IGF-I also increases the likelihood that this diagnosis is correct .
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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.
How Reliable Are Hgh Deficiency Tests
Growth hormone deficiency testing using IGF-1 levels is extremely reliable when assessed with the other blood tests listed below. Again, please remember that the tests are confirmation of the doctors suspicion of growth hormone deficiency due to the exhibited symptoms.
Some people may require further testing, which could include any of the following:
- GH Suppression Test to help the doctor determine if the pituitary gland produces too much growth hormone
- GH Stimulation Test to determine how much growth hormone the pituitary gland releases in response to stimulating efforts
- MRI or CT Scan if the doctor suspects that a tumor is present in the hypothalamus or pituitary gland, an MRI or CT Scan may be necessary to confirm the diagnosis
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Congenital Growth Hormone Deficiency
Congenital GHD is always present since a persons birth and the symptoms occur in early childhood. The symptoms include slow growth of the child, hypoglycemia, and underdeveloped genitalia in boys. This type of deficiency is caused by:
- genetic abnormalities
- complications during delivery
- association with other genetic syndromes such as Prader-Willi and Bardet-Biedl
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.
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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.
Peak Growth Hormone Cut Off
As recombinant growth hormone became more widely available, less stringent criteria for the diagnosis of GHD were implemented with increase in peak GH cut off levels. With the renewed interest in oral GH secretagogues, a reassessment of peak GH cut offs may be helpful. The studies by Bright et al. and Blum et al. suggest that a partially intact pituitary axis is needed for GH secretagogues to be effective . Individuals with moderate growth hormone deficiency who may respond to GH secretagogues need to be differentiated from those with severe growth hormone deficiency who require growth hormone therapy .
Traditionally, the interpretation of GH stimulation testing results was binary with the adherence to pass/fail diagnostic GH cutoffs. Perhaps, instead, the results should be interpreted on a continuum that spans severe GHD requiring GH therapy to moderate or provisional GHD for which alternative therapies and further monitoring of growth should be considered . There is increasing evidence supporting the need to revisit cutoffs for peak GH after stimulation based on the assay used to measure serum GH concentrations . Lower cutoffs for peak GH levels based on specific assays have been proposed. The establishment of method-specific clinical evidence-based GH cutoff limits would help ensure adequate clinical diagnoses.
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Growth Hormone Deficiency Treatment
How is growth hormone deficiency treated? Hormone replacement therapy is one of the most effective, safe and popular ways to treat a growth hormone deficiency. Only a doctor can prescribe the correct therapy for you when you partake in HRT. He or she will analyze your medical information and determine which hormone you are lacking.
Once a doctor knows that growth hormone is depleted in your system, he or she will then decide which of the most popular 5 HGH medications would be best suited for you and your needs. The doctor will most likely choose from the following HGH medications:
- Humatrope by Eli Lilly
- Omnitrope by Sandoz
- Saizen by EMD Serono
All of the above medications are 100 percent pure, 191 amino acid sequences that are manufactured in controlled laboratories. They are only to be taken as subcutaneous injections which means that the needle is inserted just under the skin.
It is important to take the exact dosage of medication that the doctor prescribed for the best results. Take your medication as frequently as is prescribed as well and store it properly when not in use. Make sure to keep up with your medical supervision with your doctor. Treatment for a growth hormone deficiency has been clinically proven to be effective in many research studies that have been published in many of the worlds most prestigious medical journals.
Adult Growth Hormone Deficiency: Optimizing Transition Of Care From Pediatric To Adult Services
Effective transition of care from pediatric to adult services is challenging.
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Patients transitioning from childhood to adulthood often experience a care gap.
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Endocrinologists met and discussed unmet needs and optimal management of patients.
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Collaborative, multidisciplinary approaches to ensure continuity of care are needed.
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A consensus document providing practical guidance on transition care is needed.
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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.
How Do We Treat Growth Hormone Deficiencies
Once a proper diagnosis of adult onset growth hormone deficiency can be made, the most effective treatment involves growth hormone replacement therapy. Growth hormone therapy is given via injections of prescription HGH. The only way to receive authentic growth hormone therapy is with a doctors prescription, and the only way prescription growth hormone therapy is given, is with an injection. Any product or supplement that claims to be HGH, or contain HGH, that you can purchase without a prescription, or is taken in any form other than via an injection, is not HGH.
Prescription HGH shots are available under many names. Some of the most common growth hormone injections prescribed to treat GHD are:
These differ only in their level of quality, their available dosages, and their delivery methods. Your medical professional will decide which is the right HGH prescription for you.
Regardless of which HGH medication you are prescribed, growth hormone therapy is the safest and most effective form of treatment for a diagnosis of adult growth hormone deficiency.
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How We Diagnose Growth Hormone Deficiency
The first step in treating your child is forming an accurate and complete diagnosis. Before a growth hormone deficiency diagnosis can be made, your child’s physician may have to rule out other disorders first, including genetic short stature , inadequate caloric intake, thyroid hormone deficiency, and other illnesses, including gastrointestinal problems.
In addition to learning your child’s complete medical history, gathering information about the heights and any health problems of your relatives, and conducting a physical examination, your child’s doctor may:
- monitor your child’s growth over a period of time
- review the mother’s pregnancy, labor, and delivery
- draw a small amount of blood to look for evidence of other diseases
- arrange for an x-ray of your child’s hand and wrist
- measure amounts of insulin-like growth factor-1 and insulin-like growth factor binding protein-3 in the blood, which are produced when the liver and other tissues are stimulated by growth hormone
Since growth hormone is produced in bursts, it is unlikely that any single blood sample will provide a definitive diagnosis.
If growth hormone deficiency is suspected, your physician may use a stimulant of growth hormone secretion , and measure the growth hormone release over time.
If growth hormone deficiency is diagnosed, your physician may order an MRI of the brain to look at the hypothalamus and pituitary gland.
What Are The Symptoms Of Adult Growth Hormone Deficiency
Symptoms of adult growth hormone deficiency are nonspecific. Some people may be asymptomatic.
Reported symptoms of adult growth hormone can be classified into five types, which include:
- Neuropsychiatric problems:
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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.
Other Chemicals Used To Increase Muscle Size
Some athletes or bodybuilders who abuse growth hormone in an attempt to gain muscle size and strength also use other medications or illicit drugs to speed up their physical transformation. The dangers of mixing these different chemicals are not fully known.Some of the substances people may use include:
- steroids synthetic versions of the male sex hormone testosterone. These build muscle tissue and aid rapid recovery
- amphetamines to aid in fat loss
- beta-blockers to counteract trembling, a common side effect of steroids
- diuretics to counteract fluid retention .
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What Causes Growth Hormone Deficiency
GHD that isnt present at birth may be caused by a tumor in the brain. These tumors are normally located at the site of the pituitary gland or the nearby hypothalamus region of the brain.
In children and adults, serious head injuries, infections, and radiation treatments can also cause GHD. This is called acquired growth hormone deficiency .
Most cases of GHD are idiopathic, meaning that no cause has yet been found.
What Do The Test Results Indicate
If the growth hormone levels do not rise during the GH stimulation test, it indicates a GH deficiency. The treatment for GH deficiency includes synthetic growth hormone injections given to the child every day at bedtime. The treatment is continued till the child reaches adult height. Most children benefit from the treatment and show an increase in the height of up to 4 inches in the first year of therapy. Early diagnosis and treatment are essential to attain expected growth and development.
Suppose the GH levels do not decrease during the GH suppression test if the patient has gigantism or acromegaly, the cause is a tumor in the pituitary that produces excess hormones. Surgical removal of the tumor is the indicated treatment. The doctor may suggest a combination of surgery, medications, and radiation in a few cases.
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What Causes Gh Deficiency In A Child
GH deficiency can be caused by damage to the pituitary gland or another gland called the hypothalamus. The injury can occur before birth , or during or after birth .
The pituitary gland is a pea-sized gland located at the base of the brain. Its the master endocrine gland in the body. The pituitary gland normally releases as many as 8 different hormones. These hormones control growth, metabolism, blood pressure, and other body processes.
In rare cases, GH deficiency can be part of a genetic syndrome. In many cases, the cause of GH deficiency is not known .