Hyposomatotropism Follow-up

Updated: Oct 30, 2015
  • Author: Sunil Kumar Sinha, MD; Chief Editor: Stephen Kemp, MD, PhD  more...
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Follow-up

Complications

Recombinant human growth hormone (rhGH), which is used to treat hyposomatotropism, has a well-established profile of adverse effects in the pediatric population.

  • rhGH reduces insulin sensitivity, resulting in hyperglycemia among patients who are predisposed to develop insulin resistance.

  • Slipped capital femoral epiphysis occurs more frequently in patients with renal or endocrine disorders or in patients undergoing rapid growth than in the general population.

Scoliosis may progress in patients with rapid growth secondary to rhGH therapy.

Intracranial hypertension with papilledema, visual changes, headaches, nausea, and/or vomiting have been reported in a small number of patients treated with rhGH. The symptoms usually occurred within the first 8 weeks of initiating rhGH therapy.

Funduscopic examination is recommended at start of rhGH therapy and at each follow-up visit.

Peripheral edema and prepubertal gynecomastia have been associated with rhGH therapy.

With the exception of slipped capital femoral epiphysis, most adverse effects associated with rhGH therapy resolve after the dosage is reduced or after therapy ends.

Potential need to discontinue rhGH therapy

  • Therapy with rhGH may need to be discontinued in patients who have acute critical conditions or illnesses, such as open heart or abdominal surgery, multiple accidental trauma, or respiratory failure. The safety of continuing rhGH treatment has not been established in patients receiving replacement doses for approved indications who concurrently develop these critical illnesses.

  • In a study of adults without GHD who were hospitalized for critical illness, supplemental rhGH therapy may have been associated with a significant increase in mortality rates.

  • Jeschke et al performed a prospective, randomized, placebo-controlled study in pediatric patients hospitalized for severe burns. [14] The mortality risk did not increase with rhGH therapy.

Potential association between rhGH therapy and leukemia

  • Watanabe and colleagues reported an increased frequency of leukemia in Japanese children who were treated with rhGH. [15] Several investigators subsequently examined the potential relationship between rhGH therapy and leukemia.

  • Children with GHD have more risk factors that predispose them to develop leukemia than do children in the general population. These factors include the following:

    • Previous episodes of cancer

    • Treatment with modalities such as irradiation and chemotherapy

    • Comorbid conditions, such as, Down syndrome, Bloom syndrome, or Fanconi syndrome

  • Examination of large databases reveals that the incidence of leukemia is not elevated among rhGH-treated patients without these additional risk factors. In addition, no current evidence suggests that the risk of leukemia or brain-tumor recurrence rises in patients receiving long-term rhGH treatment.

  • Patients with cancer in remission who require rhGH should be evaluate carefully. The pediatric endocrinologist and the oncologist should assess the appropriateness of rhGH therapy on an individual basis.

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Prognosis

The prognosis depends on the underlying etiology of growth hormone (GH) deficiency (GHD).

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