Growth Hormone Deficiency
Growth Hormone deficiency is a rare disorder occurring roughly 1 in 7,000 births. GHD is due to the lack of Growth Hormone, a hormone produced by the pituitary gland. Although very rare, Growth Hormone deficiency can also occur in adults caused by infections, radiation treatments, serious head injuries, or a tumour located in proximity to the pituitary gland or the hypothalamus region of the brain. This is known as Acquired Growth Hormone Deficiency(AGHD)
Growth Hormone deficiency can be classified into three groups; Acquired GHD, Congenital GHD and Idiopathic GHD.
What causes Growth Hormone Deficiency?
- acquired GHD
AGHD normally occurs in adults. It is usually acquired later in life as a result of infection, radiation therapy, tumour growth within the brain, trauma, hormonal problems related to the hypothalamus or pituitary gland and poor blood supply to the pituitary gland
- congenital GHD
Congenital Growth Hormone Deficiency is the most popular, it is present from birth, usually as a result of structural defects within the brain or gene mutations. Although present at birth, childhood-onset growth hormone deficiency is not inherited. It is in a very rare and few cases that growth hormone deficiency can follow bloodline, but just about 3% of the cases.
- idiopathic GHD
Idiopathic Growth Hormone has no known or medical diagnosable cause. It just happens spontaneously.
How Growth Hormone Deficiency is diagnosed?
- In children
Growth Hormone Deficiency in children is quite easy to diagnose. The child`s growth rate would be probably very slow compared to his or her mates. The paediatrician would compare the child`s height and weight with the averages of children of that age. A series of question would follow both to the child and to the parent concerning their growth rate as they were growing as well as the growth rates of their other children. After that a few tests would have to be carried out to confirm the diagnosis. Due to diurnal variation, during daytime the levels of Growth Hormone are usually very low and tend to fluctuate a lot. Therefore a single positive blood test which confirms a lower-than normal amount of Growth Hormone is not enough evidence.
To make the test more accurate, it is important to focus not only on the present amount of GH in the blood but to measure the amount of GH produced after stimulation by a Growth Hormone secretion inducing agent at a specified period of time. The child is given something to stimulate release of Growth Hormone like insulin, arginine or glucagon. The levels of GH would then be checked by blood tests over the next 2-3 hours.
Last but not least is an x-ray test. Growth plates permanently join together when you have finished developing. A child`s x- ray can provide enough information about the child development, whether development has ended or its still continuing.
Kidney and thyroid function tests can also be used to evaluate how the body is producing and using hormones. Generally the testing process is complex and requires an expert paediatrician specialising in children`s hormones, paediatric endocrinologist.
- In Adults
Diagnosis in adults is carried out by giving the patient, a substance which triggers the release of Growth Hormone in the body. The most commonly used test is the insulin tolerance test. However the test can be uncomfortable in certain individuals like epileptic and heart disease patients. In these cases arginine or glucagon can be used as they also have the ability to stimulate growth hormone release.
The amount of Growth Hormone released during the test determines whether the test is negative or positive. If the amount of HGH released exceeds the standard amount, the patient is GHD negative but if its below the standard, the patient is GHD positive.
Growth Hormone Deficiency symptoms in adults
In adults, it is quite difficult to diagnose the symptoms Growth Hormone Deficiency as they are mostly similar to other diseases. GHD drastically reduces quality of life, both professionally and socially. Some of the common symptoms are:
- Decreased stamina along with low energy levels.
- A significant decrease in muscle mass and strength.
- Complications in the blood circulatory system.
- High risk of cardiovascular diseases as result of abnormalities in the quantity of good and bad cholesterol.
- Increase in body fat especially around the waist.
- Abnormalities in concentration and memory.
Growth Hormone Deficiency Treatment
After the ban of extraction of Growth Hormone from cadavers in 1985, Genetech introduced recombinant. Ever since, synthetic Growth Hormones have been successfully used to treat adults and children suffering from GHD.
Soon after diagnosis, treatment should be administered with immediate effect to optimize the growth potential. Growth is at its peak during puberty. Therefore a large amount of Growth Hormone is also required during puberty. Thus the dosage is usually maximised during adolescence and stopped during or near completion of skeletal maturation. After skeletal maturation, the patient has to do retesting to confirm if Growth Hormone is needed as an adult.
Growth hormone is administered in the form of an injection into the body`s fatty tissues, such as buttocks, the back of the arms, thighs.
- In Adults
In adults the first step of treatment is education and support usually from endocrinology nurses. Once treatment has been initiated, the individuals are carefully monitored and given given regular blood tests. The patient`s dosage would be regulated depending patient`s response to the medication and blood test results.
- In Children
Needles can be very uncomfortable in children therefore there are some injection methods which do not involve needles. Growth Hormone injection is normally administered in the evening to fit in with the body’s natural cycle of growth hormone production. Special monitoring to ensure the correct dose, and information regarding the most appropriate injection device is very important to follow accordingly. There is no standard quantity of GH to be taken as it varies from patient to patient depending on the size and weight of the child.
It is mostly effective to take daily doses. Children born with congenital GHD usually undergo treatment until they reach puberty. Children often require higher levels of Growth Hormone than adults. Thus some kids can have GHD in their childhood and leave normal lives during adulthood. Nonetheless a few unfortunate ones continue treatment their entire lives.
The following drugs have been approved by the FDA for treatment of Growth Hormone deficiency:
- somatropin (Nutropin [Genentech)] Humatrope [Lilly],
- Genotropin [Pfizer],
- Saizen [EMD Serono],
- Norditropin [Novo Nordisk],
- Tev-Tropin [Teva]
- Omnitrope [Sandoz].
In a very few cases long-term administration of growth hormone injections has been reported to contribute to the development of diabetes. Nonetheless most of the patients already had a family history of diabetes.
Growth Hormone treatment Side Effects
Unless the dosage is really too high, Growth Hormone therapy usually has a few to zero side effects. In a very few casual cases, the following symptoms are experienced:
- Retention of fluid in the joints causing discomfort. A decrease in the dosage usually alleviates this problem instantly.
- Elevation of blood sugar levels in the body.
- Blurred vision Headaches
- redness at the injection site
- hip pain
- scoliosis or curving of the spine
If the aforementioned symptoms become severe, cancellation of the treatment is required. It usually stops the symptoms. Unfortunately taking growth hormone will not increase height in adults.
Symptoms of Growth Hormone Deficiency:
- In Children
As mentioned earlier, its very easy to notice Growth hormone deficiency in children. Stunted growth is the most obvious symptom of growth hormone deficiency in children. The child would be significantly shorter than other kids his or her age. A child with GHD can have normal body proportions.
Children with normal levels of Growth Hormone grow by 2.5-4 inches a years and children with GHD only grow nothing more than 2 inches per year. Below are some other growth hormone deficiency symptoms in children:
- The child has Delayed puberty or totally misses it.
- Increased amount of fat around the stomach and face.
- Moderate chubbiness
- Baby face, the child’s face may look younger compared to children who are of the same age
- Reduced tooth development
- Poor hair growth
- In Adults
There are usually no specific symptoms to Growth Hormone deficiency. Some of the symptoms associated with Growth Hormone Deficiency are:
- Depression and/or Anxiety.
- Loss of hair(Baldness in men).
- Loss of sexual libido.
- Reduced muscle mass and strength.
- Impairment of concentration and memory.
- Thin and dry skin.
- Increased levels of triglycerides.
- Tiredness and or fatigue.
- Cardiovascular diseases.
- High levels of bad cholesterol, LDL cholesterol.
- Insulin resistance.
- Less endurance during exercise.
- Decreased bone density which gradually leads to osteoporosis.
- Exaggerated sensitivity to heat and cold.
- Increase in body weight, especially around the waist.