Pediatric Growth Hormone Deficiency Treatment & Management
- Author: Stephen Kemp, MD, PhD; Chief Editor: Bruce Buehler, MD more...
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. 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. 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.
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.
Pediatric endocrinologists see almost all children with growth hormone deficiency (GHD).
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