Medication Summary
Growth hormone (GH) is approved by the FDA for treatment of growth failure caused by the following: growth hormone deficiency, Turner syndrome, chronic renal insufficiency, intrauterine growth failure with postnatal growth failure, Prader-Willi syndrome, and idiopathic short stature.
Growth Hormone
Class Summary
These agents are used for physiologic replacement of growth hormone deficiency and are used pharmacologically as a growth-promoting agent in patients with Turner syndrome, chronic renal insufficiency, intrauterine growth failure, Prader-Willi syndrome, or idiopathic short stature.
Somatropin (Humatrope, Nutropin AQ, Genotropin, Norditropin, Omnitrope, Saizen, Tev-Tropin, Zorbtive)
Recombinant DNA origin GH. In children whose epiphyses are not yet fused, GH therapy usually results in a significant increase in growth velocity (averaging 10-11 cm/y during the first year of therapy in GH deficiency and 7-9 cm/y during the first year in other disorders). Response wanes each year, but growth velocity continues to be faster than pretreatment rates.
Androgen
Class Summary
Oxandrolone, along with growth hormone, has been used in Turner syndrome to potentiate the growth-promoting effect of growth hormone.
Oxandrolone acetate (Oxandrin)
Synthetic testosterone derivative. A weak androgen that cannot be aromatized to estrogen.
Insulinlike growth factor
Class Summary
IGF-I (mecasermin) has been approved by the FDA for primary severe IGF-I deficiency. Some children with idiopathic short stature may have a degree of growth hormone insensitivity; these children may benefit from treatment with IGF-I. Clinical studies are presently in progress to determine whether this hypothesis is correct.
Mecasermin (Increlex)
Recombinant human IGF-1 indicated for long-term treatment of growth failure in children with severe (ie, basal IGF-1 and height SD scores ≤ -3, normal or elevated GH level) primary IGF-1 deficiency (primary IGFD). IGF-1 is essential for normal growth of children's bones, cartilage, and organs by stimulating glucose, fatty acids, and amino acid uptake into tissues. IGF-1 is the principal hormone for statural growth and directly mediates GH effect. Primary IGFD is characterized by lack of IGF-1 production despite normal or elevated GH levels.
Gonadotropin Releasing Hormone Analog
Class Summary
Gonadotropin-releasing hormone analog has been occasionally used to try to slow the onset and progression of puberty, thus resulting in a longer time for growth. Studies have demonstrated a small, but statistically significant, increase in predicted adult height. The effect seems to be greater if early puberty is is interrupted with this therapy. Part of the problem of using this therapy is that children who are experiencing short stature are troubled by being different, and delaying puberty beyond a normal point is also making them different from their peers.
Leuprolide acetate (Lupron)
Suppresses ovarian and testicular steroidogenesis by decreasing LH and FSH levels.
Aromatase Inhibitor
Class Summary
Maturation of the skeleton has been shown to be the result of estrogen in both boys and girls. Studies have shown that inhibiting conversion of androgen to estrogen for a period of 3 years may result in increases in adult height prediction by as much as 3 inches or more. Actual adult height data are pending, although these data are just beginning to appear.
Letrozole (Femara)
Letrozole is an aromatase inhibitor, which interferes with the conversion of androgen to estrogen.
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