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Pediatric Growth Hormone Deficiency Treatment & Management

  • Author: Stephen Kemp, MD, PhD; Chief Editor: Bruce Buehler, MD  more...
 
Updated: May 27, 2014
 

Medical Care

Initially, growth hormone was injected intramuscularly; however, in the mid 1980s (about the time recombinant human growth hormone [rhGH] became available) it was shown to be as effective when administered as a subcutaneous injection.[14] This is the current practice.

Early in its use, growth hormone was administered twice weekly; this was increased to 3 times weekly when the higher frequency was shown to result in an increased growth response.[15] At about the time of the transition from cadaveric growth hormone to rhGH, daily injections (6-7 injections per week) were shown to yield an even better growth response than administering injections 3 times per week.[16, 17, 18, 19] Thus, daily administration is now commonly used.

A multicenter, randomized, controlled dose-response trial of 35 children in the Netherlands found that final adult height was 4-5 cm less than target height in patients administered growth hormone does of 0.7 mg/m2/d, whereas adult height was 0-2 cm less than target height in patients receiving 1.4 mg/m2/d; however, this difference was not statistical significant, likely due to the limited numbers of patients, variation in growth response, and earlier spontaneous puberty and pubertal induction in children receiving 1.4 mg/m2/d.[20]

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.

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Consultations

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

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Contributor Information and Disclosures
Author

Stephen Kemp, MD, PhD Former Professor, Department of Pediatrics, Section of Pediatric Endocrinology, University of Arkansas for Medical Sciences College of Medicine, 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, Southern Society for Pediatric Research

Disclosure: Nothing to disclose.

Specialty Editor Board

Mary L Windle, PharmD Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

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 Medical Association, American Pediatric Society, Association of Clinical Scientists, Endocrine Society, Florida Medical Association, Pediatric Endocrine Society, Society for Pediatric Research, Southern Society for Pediatric Research, Society for the Study of Reproduction, American Federation for Clinical Research, Pituitary Society

Disclosure: Nothing to disclose.

Chief Editor

Bruce Buehler, MD Professor, Department of Pediatrics and Genetics, Director RSA, 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 Intellectual and Developmental Disabilities, American College of Medical Genetics and Genomics, American Association for Physician Leadership, American Medical Association, Nebraska Medical Association

Disclosure: Nothing to disclose.

Additional Contributors

Arlan L Rosenbloom, MD Adjunct Distinguished Service Professor Emeritus of Pediatrics, University of Florida College of Medicine; 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, Pediatric Endocrine Society, Society for Pediatric Research, Florida Chapter of The American Academy of Pediatrics, Florida Pediatric Society, International Society for Pediatric and Adolescent Diabetes

Disclosure: Nothing to disclose.

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