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.
Clinical Features Of Ghd
The function of several organ systems is directly altered by the loss of the physiologic effects of GH. Acquired isolated GHD is characterized by weight gain, increased fat mass, and decreased lean body mass . AGHD patients have 7% higher total body fat, with similarly decreased LBM . Central adiposity lends to increased waist:hip ratio. In addition, triglyceride levels are increased and high density lipoprotein levels decreased. This alteration in lipid levels may explain, in part, the observation of increased intima-medial wall thickness , as measured by carotid ultrasonography, in this population . These factors may contribute to the increased incidence of cardiovascular mortality seen in patients with GHD.
Decreased muscle mass and strength are also present in GHD patients. In the heart, these changes are manifested by reduction in left ventricular mass, decreased fractional shortening of cardiac myocytes, and decreased cardiac output. Such abnormalities may contribute to the decline in exercise capacity. Amato et al. demonstrated a reduction in exercise capacity by 2025% in GHD patients compared to normal controls. In addition, cortical bone density and trabecular bone density measurements in GHD patients were 2.8 and 1.5 SD, respectively, below the mean age and sex matched controls .
Table 1. Adult growth hormone deficiency quality of life assessment .
The signs and symptoms of GHD are summarized in Table 2 .
Table 2. The syndrome of adult growth hormone deficiency .
What Triggers Human Growth Hormone
Your pituitary gland normally releases hGH in short bursts throughout the day. The release of hGH is mainly controlled by two hormones your hypothalamus releases: growth hormone-releasing hormone , which stimulates hGH release, and somatostatin, which prevents hGH release.
Several other endocrine hormones also regulate hGH, including insulin-like growth factor 1 . IGF-1 is a major suppressor of GH production, whereas thyroxine, glucocorticoids and ghrelin stimulate hGH release.
IGF-1 thats released by your liver is one of the best-characterized effects of hGH activity. IGF-1 plays a critical role in preventing the release of the hGH through a negative feedback loop by stimulating somatostatin and inhibiting GHRH release. However, hGH and IGF-1 secretion are regulated by each other, where hGH triggers IGF-1 release and the IGF-1 inhibits hGH release in a feedback loop. In healthy people, hGH release is inhibited by hyperglycemia and stimulated by sleep, stress, exercise, hypoglycemia and amino acids.
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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.
Appendix: Summary Of Changes From The 2006 Guideline
Overall, the Guideline has been changed to reflect the structure of the newer guidelines, with each section started by the Recommendation or Suggestion, followed by the Evidence, and then sections on Remarks or Values. The more recent literature has been reviewed, new information and references have been provided, and some older information and references have been deleted.
A. The introduction has been greatly shortened.
B. Recommendation 1.3 regarding idiopathic GHD has been added.
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 .
This specifically states that to make a diagnosis of idiopathic GHD in adults, decreased GH responses to two appropriate stimulation tests are needed. It was felt that elevation of the previous discussion about this to the level of a recommendation was needed to reemphasize that inappropriate use of GH in adults is not to be done.
C. Recommendation 2.1 regarding the ITT and GHRH-Arg testing was expanded.
D. Recommendation 2.2 regarding use of glucagon as a stimulation test has been added.
E. Recommendation 2.3 regarding the retesting of those with childhood GHD was expanded.
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Reduce Your Sugar Intake
An increase in insulin is associated with lower HGH levels.
Refined carbs and sugar raise insulin levels the most, so reducing your intake may help optimize growth hormone levels .
One study found that healthy people had 34 times higher HGH levels than those with diabetes, as well as impaired carb tolerance and insulin function .
Along with directly affecting insulin levels, excess sugar intake is a key factor in weight gain and obesity, which also affect HGH levels.
That said, the occasional sweet treat will not impact your HGH levels in the long term.
Aim to achieve a balanced diet, as what you eat has a profound effect on your health, hormones, and body composition.
Summary Elevated insulin levels may reduce HGH production. Therefore, limit your intake of large amounts of sugar and refined carbs.
Given that most meals cause a rise in insulin levels, some experts suggest avoiding food before bedtime .
In particular, a high-carb or high-protein meal may spike your insulin and potentially block some of the HGH released at night .
Keep in mind that insufficient research exists on this theory.
Nevertheless, insulin levels normally decrease 23 hours after eating, so you may wish to avoid carb- or protein-based meals 23 hours before bedtime.
Summary More research is needed on the effects of nighttime eating on HGH. Still, it may be best to avoid food 23 hours before bed.
Treatments Can Help Provide Better Outcomes
Growth hormone deficiency is a growth disease associated with inadequate secretion of growth hormone from the pituitary gland, the “master gland” in the brain.1
- What is Growth Hormone Deficiency?
Growth hormone deficiency is a rare disease that can be caused by genetic mutations or acquired after birth.1 Because the patient’s pituitary gland secretes inadequate levels of somatropin, the hormone that causes growth, his or her height will be affected and puberty delayed.2 Without treatment, the child will have persistent growth failure, a very short height in adulthood, and may experience other health problems.1
- Who gets Growth Hormone Deficiency?
Growth hormone deficiency affects one in approximately 4,000 to 10,000 people.3 It can be congenital , or acquired after birth, due to trauma, brain tumor, surgery, or radiation therapy.1 It can also be idiopathic, in which case its cause is unknown.1 In some cases, it can result when patients also have other hormone deficiencies, including the hormones that activate the thyroid and adrenal glands.4
- What are the Symptoms of Growth Hormone Deficiency?
The symptoms include:1
- Muscle and joint aches
- Slippage of the hip bone
The condition results in a delay in the lengthening of the long bones of the extremities, resulting in abnormal growth for the child’s age.1
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Ways To Boost Human Growth Hormone Naturally
Human growth hormone is an important hormone produced by your pituitary gland.
Also known as growth hormone , it plays a key role in growth, body composition, cell repair, and metabolism .
HGH also boosts muscle growth, strength, and exercise performance, while helping you recover from injury and disease .
Low HGH levels may decrease your quality of life, increase your risk of disease, and make you gain fat (
Those with higher levels of belly fat will likely have impaired HGH production and an increased risk of disease.
One study observed that those with three times the amount of belly fat as the control group had less than half their amount of HGH .
Another study monitored the 24-hour release of HGH and found a large decline in those with more abdominal fat.
Interestingly, research suggests that excess body fat affects HGH levels more in men. However, lowering body fat is still key for both genders .
Whats more, a study found that people with obesity had lower levels of HGH and IGF-1 a growth-related protein. After losing a significant amount of weight, their levels returned to normal .
Belly fat is the most dangerous type of stored fat and linked to many diseases. Losing belly fat will help optimize your HGH levels and other aspects of your health.
Get rid of excess body fat especially around your belly to optimize your HGH levels and improve your health.
Sga Is Associated With Non
Adult metabolic syndrome is a disease, in which conditions such as insulin resistance, hypertension, glucose intolerance, central obesity, and dyslipidaemia are commonly co-present, leading to an increased risk of cardiovascular disease. Although for a long time a controversial issue, there is now evidence for an increased prevalence of metabolic syndrome among adults who were born SGA and it is, therefore, important that their height, weight, and body mass index are closely monitored to prevent excessive weight gain, as children born SGA who catch up in weight and height are at a higher risk than those without catch-up . The relative risk of developing metabolic syndrome as an adult is greatest in those with catch-up growth, but is still greater in those without catch-up growth as compared with AGA neonates. The presence of insulin resistance in SGA requires improved understanding, but raises the question of hormonal resistance underlying the SGA condition throughout life .
In summary, SGA is associated not only with shorter than average height, but also with potential health disadvantages, such as reduced body fat and a lack of appetite as compared with individuals who were not born SGA there is also an increased prevalence of metabolic disorders in later life among patients born SGA as compared with those born AGA.
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How Does Hormone Replacement Therapy Work
Upon the initial consultation, you will describe your symptoms and what you are feeling on a daily basis. Your blood tests will then be analyzed to look at IGF-1 levels, HGH release, and insulin resistance levels.
If everything is well in order, you will have either pure HGH or something to increase the HGH prescribed. After payment, it is shipped to your door and you work hand in hand with the clinic to ensure your HGH products are working well and not causing you side effects.
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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Factors Affecting Adherence To Gh Therapy
Barriers to GH therapy adherence in paediatric patients may include medication issues , scheduling issues and cognitive/emotional issues . Additional barriers in adolescence may include: denial, peer pressure and reluctance to seek medical advice .
Factors specifically associated with poor adherence to GH therapy in observational studies are listed in table 2 notably, several factors have been associated with poor adherence in some studies but not in others.
Factors associated with poor adherence to GH therapy in paediatric patients
Who Should Not Receive The Growth Hormone Treatment
The following should not take growth hormones:
- Those with cancer or tumor
- Those with multiple trauma injuries
- People suffering from severe breathing problems
A growth hormone deficiency could increase the risk of heart disease, diabetes, osteoporosis, strokes, and high blood pressure if left untreated.
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Interventions To Improve Adherence To Gh Therapy
It is evident from the above that there is a need for effective interventions to improve the adherence to GH therapy in paediatric patients. To our knowledge, there is only 1 published randomised controlled trial addressing this issue, which found no difference in adherence between patients who had been allocated a needle-free injection device and those allocated a multi-dose injection pen . Based on injection-device acceptability studies, observational studies of GH therapy adherence and studies of other paediatric diseases, a number of interventions have been proposed to improve adherence to GH therapy .
Interventions that have been proposed to improve adherence to GH therapy in paediatric patients
Other Treatments For Growth Hormone Deficiency
In addition to growth hormone therapy, you may need other treatments for growth hormone deficiency.
For example, being very short can affect a childs self-esteem: Classmates can tease a child to the point of tears. Thats why mental and emotional therapy is often an important part of treatment. A mental health counselor or psychologist can talk you through your feelings and teach you how to cope with growth hormone deficiency.
Getting enough sleep, eating a balanced diet, and regularly exercising are also important parts of an overall growth hormone deficiency treatment plan. Your doctor can teach you how to incorporate growth hormone injections into a healthy lifestyle.
Adult growth hormone deficiency. Cedars-Sinai Medical Center Web site. . Accessed May 16, 2011.
Growth hormone deficiency. Health Guide. New York Times Web site. . Published September 13, 2009. Accessed May 16, 2011.
Growth hormone deficiency – children. MedlinePlus Web site. . Update July 26, 2010. Accessed May 16, 2011.
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S Used In The Development Of This Guideline
This guideline was developed by the Insurance Committee of the Korean Endocrine Society in consultation with the Korean Neuroendocrine Study Group, and the Korean Society of Pediatric Endocrinology. Since there are currently no diagnostic guidelines for GH deficiency and few domestic research has been conducted on this topic, the basis of this guideline was formed by consensus from panel discussion of experts, and the review of existing literature. When evidence was insufficient, recommendations were written according to expertsâ opinions. When there were differences in opinions, a majority vote was taken. Each recommendation was graded according to the strength of evidence supporting the recommendation, as defined in Table 2.
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Cellular And Molecular Conditionings Of Gh Therapy
GH initiates it action by binding to growth hormone receptors present on the plasma membrane of target cells. GHRs belong to the class I cytokine receptor family along with prolactin, erythropoietin, leptin and interleukins receptor . The GHR receptor polymorphism has been extensively studied . The GHR is a membrane receptor composed of 638 amino acids with three cellular domains: an extracellular, a transmembrane and an intracellular domain. The extracellular domain attaches to the circulating GH and corresponds to the circulating GH binding protein . Activation of the receptor is induced through the interaction of GH to a preformed GHR dimer, leading to a conformational change in the intracellular domain that results in the phosphorylation and activation of STAT5 through Janus Kinase 2 .
Taking into account the studies published to date, there is little evidence that GHR polymorphism have an important impact in the clinical manifestations of the syndrome of adult GHD. The importance of the d3-GHR variant on the response of adult GHD patients to GH replacement is unclear at the present time .
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