HGH In Children
HGH plays a huge role in human growth. In children, HGH deficiency leads to abnormally slow growth and noticeably short stature but with normal proportions. To establish HGH deficiency, the diagnosis process involves a series of pituitary hormone level measurements. There are CT and MRI examinations, as well as, other tests to look for anomalies.
Measuring A Child’s Height
There are a lot of questions going through a parent’s mind once their child is diagnosed with HGH deficiency. Is it treatable? Does it have long-term effects on the child? What do I do next?
What do low HGH levels mean?
HGH deficiency in children means that the pituitary gland located at the base of the brain does not produce sufficient growth hormones. The hormones travel throughout the body to facilitate growth and other complex functionalities. If not in the right amount, the child develops at a relatively slow rate and the final height is reduced.
What are the causes?
A child can be born with a defect or acquire it as they grow. Most HGH deficiency cases are referred to as idiopathic– meaning that the cause is unknown.
In some cases the causes of HGH deficiency are of genetic, syndromic, or acquired nature:
Genetic or congenital HGH deficiency – means that the problem originates from a certain gene involved with growth hormone production. Genetic HGH deficiency is not typically passed on from parents to babies. However, experts state that babies born with certain defects like cleft palate are likely to suffer from HGH deficiency.
Syndromic HGH deficiency – means that the problem began when the child was still in the mother’s womb. The problem occurred during the baby’s brain development process where the pituitary gland failed to produce enough growth hormones.
Children just like adults can develop acquired HGH deficiency later in life as a result of brain injuries, tumors, or infections.
Other causes of HGH deficiency are:
- Head tumors
- Severe head injury
- Brain surgery
- Inadequate blood supply to the brain
- An infection
- Brain radiation treatment
- Hypothalamus gland hormone problems, etc.
Low HGH level tests
To test for HGH deficiency doctors have to check the somatotropin levels – the hormone that stimulates growth to keep our bones, muscles, and tissue healthy.
Blood/hormones test
To establish if a child has HGH deficiency, it is necessary to take various simple blood tests and hormone tests as well. The growth hormone stimulation test uses 2 medications to raise or stimulate the number of growth hormones the body produces. From this test, the doctor can determine how sufficient or lacking your child’s pituitary glands are.
Preparation
To prepare your child for this test:
- The child should not have any food past midnight and on the test day.
- Some medications should not be taken the night before and on the day of the test. If you need to give a child any medication, make sure you consult with a doctor before giving it to your child. Clonidine- one of the medicines that are used does not mix well with Adderall, Ritalin, and Amphetamines. For safety purposes get approval from a physician.
- Be ready to spend a considerable amount of time at the clinic because the tests take time. Bring your child books, videos, and other engaging material. Also, make sure you are both in comfortable attire.
Procedure
- An IV line is placed on the child’s arm or hand.
- After giving blood, the child is given a dose of clonidine, glucagon, or arginine to stimulate hormone secretion by the pituitary gland. Insulin is not commonly used in children for safety purposes like low blood sugar.
- During the test process, an assistant collects small amounts of blood samples in intervals of 30 minutes throughout the procedure for monitoring.
- Blood samples are checked for IGFBP-3 and IGF-1 alongside stimulation tests.
Results
The results usually take a few days to be out, low levels of growth hormone indicate:
- Slow growth
- Possible dwarfism
- Hypopituitarism- means that the child’s pituitary gland isn’t working as it is supposed to
- Acromegaly-more growth of some body parts
- Weak bones
- Fatigue
- Delayed puberty
Since growth hormone issues are closely related to other glands like the thyroid gland, a specialist will ask for more tests. If a doctor suspects a tumor, they will recommend an X-ray, CT scan, or MRI.
Measurements test
A pediatrician can diagnose a child during a routine clinic visit if the child’s weight, height, and head size do not compare to the normal range.
Children less than the 3rd percentile in height compared to children of their age are more likely to be suffering from growth hormone deficiency.
Treatment
Although most people with growth hormone deficiency never find out the actual cause, some treatments can help.
Growth Hormone Therapy
GH therapy is the most common form of treatment for human growth hormone deficiency in children as well as in adults. It involves the injection of the GH hormone (somatropin) into the body to stimulate cell reproduction and growth.
When the doctor prescribes growth hormone therapy, it means administering daily doses of treatment. However, depending on the severity of every condition, injection doses often vary. Injections can be administered at home by an adult.
Usually, the patient is expected to visit the doctor every 4-8 weeks throughout treatment so that the condition can be monitored. The doctor takes blood samples to determine progress and to establish whether the growth hormone therapy should continue.
Your doctor will also check the blood sugar levels, bone density, and cholesterol levels throughout the growth hormone therapy to ensure they are at acceptable levels. These injections can affect the body’s response to insulin which controls glucose levels. Untreated HGH deficiency could result in high cholesterol.
Children on Growth hormone therapy injections grow about 4 inches or more during the first treatment year. In the next 2-3 years, they grow around 3 or more inches. After the 3rd year, the growth rate gradually decreases
Is GH Therapy Safe?
Growth hormone injections are quite safe and effective but there are a few effects like; mild pain, numbness, muscle, and joint aches, and swelling. Luckily, no serious side effects are often reported.
A child may get these side effects if they are injected with more growth hormone than the body needs. Signs of these effects should be reported to the doctor immediately. The dose will be adjusted accordingly and the symptoms should fade away as the body adjusts.
People suffering from tumors, or cancer, have had multiple traumatic injuries, or have severe respiratory problems should not undergo growth hormone therapy
Other forms of treatment
In addition to therapy, there are other ways to address HGH deficiency
Counseling- for example for very short children, self-esteem is a major issue that messes up with their mental and emotional health. A psychologist or mental health specialist should be part of the treatment process.
Healthy Lifestyle- make sure the child gets adequate sleep, a balanced diet, and exercise as an overall treatment plan.
Conclusion
Insurance should cover HGH deficiency treatment which is quite expensive. However, insurance will deny coverage if HGH injections are used for ‘off label’ purposes like muscle and stamina growth, improved metabolism, height increase when dwarfism is not present, or increased bone density.
References
Cedars-Sinai Medical Center. Growth Hormone Deficiency in Children. Retrieved from https://www.cedars-sinai.org/health-library/diseases-and-conditions—pediatrics/g/growth-hormone-deficiency-in-children.html
Kyriaki S. Alatzoglou, Emma Alice Webb, Paul Le Tissier, Mehul T Dattani, Isolated Growth Hormone Deficiency (GHD) in Childhood and Adolescence: Recent Advances, Endocrine Reviews, Volume 35, Issue 3, 1 June 2014, Pages 376–432, https://doi.org/10.1210/er.2013-1067
Siebert DM, Rao AL. The Use and Abuse of Human Growth Hormone in Sports. Sports Health. 2018;10(5):419-426. https://doi.org/10.1177/1941738118782688
Brod, M., Alolga, S.L., Beck, J.F. et al. Understanding burden of illness for child growth hormone deficiency. Qual Life Res 26, 1673–1686 (2017). https://doi.org/10.1007/s11136-017-1529-1
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