growth%20hormone%20deficiency%20(pediatric)
GROWTH HORMONE DEFICIENCY (PEDIATRIC)
Growth hormone deficiency is a congenital or an acquired growth hormone axis disruption in the higher brain, hypothalamus or pituitary which results in short stature.
It may occur at any age.
Short stature is often the only feature present in patients with growth hormone deficiency and other causes of subnormal growth rate.
Etiology may be congenital conditions (eg defective pituitary development that leads to pituitary aplasia, empty sella, encephalocele, midline defects) or acquired conditions (eg tumors of the hypothalamic-pituitary region, cranial irradiation, infiltrative disease).

Growth%20hormone%20deficiency%20(pediatric) Management

Monitoring

Prescribed End Points

  • IGF-I in normal range for age and sex
    • Increase dose if IGF-I is low and decrease dose if IGF-I is above normal range
  • Improvement in blood lipid profile, body composition (change in lipolysis and increase in bone density) and waist-hip ratio
  • Increased muscle strength and exercise performance
  • Reduction in cardiovascular risk factors

Patient Monitoring

  • Close follow-up care with an endocrinologist is recommended to monitor the child’s growth, assessment of potential adverse effects, and to adjust the dose of growth hormone (GH) therapy
  • Initial follow-up should be every month; thereafter, visits may be less frequent but should be at least 2x/year
  • Children on GH therapy should be evaluated every 3-6 months, with increases in height and height velocity as the most important indicators of response
  • Monitor thyroid function every 6 months
  • Bone age, HbA1c levels, and adrenal function should also be assessed regularly
  • Monitor patients for hyperglycemia because GH may reduce insulin sensitivity; patients with diabetes mellitus (DM) may need to adjust their insulin during treatment
    • Serum IGF-1 and IGFBP-3 levels should be obtained annually to effectively monitor treatment adherence and response
    • Dose should be reduced if serum IGF-1 levels increase above the normal range
  • Funduscopic examination is recommended at the start of therapy and periodically during the course of treatment
  • GH treatment is meant to be a replacement therapy and can only be expected to make short children grow at a normal growth rate
  • Most children treated with GH replacement reach a normal adult height
    • Child’s growth usually increases most during the 1st years, with an average increase of 8-10 cm/year
    • Growth rate slows down over the next several years
    • Re-evaluation should be done at least 1 month after patient completes GH treatment
  • Adolescent patients with GHD secondary to structural pituitary or brain tumors transitioning into adulthood should be instructed to strictly adhere to follow-up schedule during this period as these patients tend to have lower bone mineral density, impaired bone microarchitecture and more adverse body composition abnormalities and cardiovascular risk markers
    • May resume GH replacement during the transition period even after final height has been achieved in patients with confirmed persistent GHD
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