eMedicine Specialties > Pediatrics: General Medicine > Endocrinology

Growth Hormone Deficiency: Treatment & Medication

Author: Stephen Kemp, MD, PhD, Professor, Department of Pediatrics, Section of Pediatric Endocrinology, University of Arkansas and Arkansas Children's Hospital
Contributor Information and Disclosures

Updated: Sep 15, 2008

Treatment

Medical Care

Although growth hormone is normally secreted in multiple peaks during the day and mostly at night, a single daily injection of recombinant growth hormone can provide physiologic replacement. In order for growth hormone replacement to be effective, other pituitary deficiencies should be treated. Response to growth hormone therapy is measured (every 3-6 mo) by sequential height determinations and by occasional bone age determinations.

Consultations

Pediatric endocrinologists see almost all children with growth hormone deficiency (GHD).

Medication

Growth hormone replacement is used to treat growth hormone deficiency (GHD).

Growth hormones

These agents are used for physiologic replacement.


Somatropin (Genotropin, Humatrope, Norditropin, Nutropin, Saizen, TevTropin)

Purified polypeptide hormone of recombinant DNA origin. In children whose epiphyses are not yet fused, GH replacement usually causes significant increase in growth velocity (averaging 10-11 cm/y during first y of therapy). Response wanes each y, but growth velocity continues at faster than pretreatment rates. A long-acting depot preparation designed for monthly or bimonthly SC injection was available but is not off the market. Other long-acting preparations are currently under investigation.

Adult

0.05-0.1 mg/kg/wk SC divided into 7 injections one sixth to one fourth of childhood dose

Pediatric

0.18-0.3 mg/kg/wk SC divided into 6-7 injections; not to exceed 0.7 mg/kg/wk during puberty
Depot: 1.5 mg/kg/month or 0.75 mg/kg SC q2wk

Excessive glucocorticoid therapy inhibits growth-promoting effect

Documented hypersensitivity; acute critical illness due to complications following open heart or abdominal surgery or multiple accidental traumas; acute respiratory failure; closed epiphyses; active neoplasia

Pregnancy

C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus

Precautions

Not indicated with functioning renal allografts; insulin dose may require adjustment in diabetes mellitus when therapy initiated; progression of scoliosis can occur in patients who experience rapid growth; discontinue use if neoplasia develops

More on Growth Hormone Deficiency

Overview: Growth Hormone Deficiency
Differential Diagnoses & Workup: Growth Hormone Deficiency
Treatment & Medication: Growth Hormone Deficiency
Follow-up: Growth Hormone Deficiency
References
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References

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  2. Rainbow LA, Rees SA, Shaikh MG. Mutation analysis of POUF-1, PROP-1 and HESX-1 show low frequency of mutations in children with sporadic forms of combined pituitary hormone deficiency and septo-optic dysplasia. Clin Endocrinol (Oxf). Feb 2005;62(2):163-8. [Medline].

  3. Blethen SL, Allen DB, Graves D. Safety of recombinant deoxyribonucleic acid-derived growth hormone: The National Cooperative Growth Study experience. J Clin Endocrinol Metab. May 1996;81(5):1704-10. [Medline].

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Further Reading

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Keywords

growth hormone deficiency GH deficiency, GHD, hypopituitarism, hypopituitary dwarfism, Creutzfeldt-Jakob disease, septooptic dysplasia, SOD, de Morsier syndrome, encephalitis, meningitis, craniopharyngioma, leukemia, CNS malformation, CNS tumor, histiocytosis, CNS infection, short stature, hypoglycemia, intrauterine growth retardation, malnutrition, delayed puberty, Turner syndrome, Noonan syndrome, Russell-Silver syndrome

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Contributor Information and Disclosures

Author

Stephen Kemp, MD, PhD, Professor, Department of Pediatrics, Section of Pediatric Endocrinology, University of Arkansas and Arkansas Children's Hospital
Stephen Kemp, MD, PhD is a member of the following medical societies: American Academy of Pediatrics, American Association of Clinical Endocrinologists, American Pediatric Society, Endocrine Society, Phi Beta Kappa, Southern Medical Association, and Southern Society for Pediatric Research
Disclosure: Genentech, Inc. Honoraria Speaking and teaching; Pfiser, Inc. Honoraria Consulting

Medical Editor

Arlan L Rosenbloom, MD, Adjunct Distinguished Service Professor Emeritus of Pediatrics, University of Florida; Fellow of the American Academy of Pediatrics; Fellow of the American College of Epidemiology
Arlan L Rosenbloom, MD is a member of the following medical societies: American Academy of Pediatrics, American College of Epidemiology, American Pediatric Society, Endocrine Society, Florida Pediatric Society, Lawson-Wilkins Pediatric Endocrine Society, and Society for Pediatric Research
Disclosure: Nothing to disclose.

Pharmacy Editor

Mary L Windle, PharmD, Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy, Pharmacy Editor, eMedicine
Disclosure: Pfizer Inc Stock Investment from broker recommendation; Avanir Pharma Stock Investment from broker recommendation

Managing Editor

Barry B Bercu, MD, Professor, Departments of Pediatrics, Molecular Pharmacology and Physiology, University of South Florida College of Medicine, All Children's Hospital
Barry B Bercu, MD is a member of the following medical societies: American Academy of Pediatrics, American Association of Clinical Endocrinologists, American Federation for Clinical Research, American Medical Association, American Pediatric Society, Association of Clinical Scientists, Endocrine Society, Florida Medical Association, Lawson-Wilkins Pediatric Endocrine Society, Pituitary Society, Society for Pediatric Research, Society for the Study of Reproduction, and Southern Society for Pediatric Research
Disclosure: Nothing to disclose.

CME Editor

Merrily P M Poth, MD, Professor, Department of Pediatrics and Neuroscience, Uniformed Services University of the Health Sciences
Merrily P M Poth, MD is a member of the following medical societies: American Academy of Pediatrics, Endocrine Society, and Lawson-Wilkins Pediatric Endocrine Society
Disclosure: Nothing to disclose.

Chief Editor

Bruce Buehler, MD, Professor, Department of Pediatrics, Pathology and Microbiology, Executive Director, Hattie B Munroe Center for Human Genetics and Rehabilitation, University of Nebraska Medical Center
Bruce Buehler, MD is a member of the following medical societies: American Academy for Cerebral Palsy and Developmental Medicine, American Academy of Pediatrics, American Association on Mental Retardation, American College of Medical Genetics, American College of Physician Executives, American Medical Association, and Nebraska Medical Association
Disclosure: Nothing to disclose.

 
 
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