Growth Disorders Symptoms

Growth Hormone Excess : Signs and Symptoms

Adults with acromegaly will usually have large hands and feet, thick lips, coarse facial features, a protruding forehead and jaw, and widely spaced teeth. Often patients perspire excessively. Many of the signs and symptoms evolve slowly, so the diagnosis is often made years after the symptoms begin.

There are numerous symptoms that may be associated with acromegaly:

• Headaches
• Numbness or burning of the hands or feet; carpal tunnel syndrome
• Glucose intolerance, (also known as insulin resistance, this condition puts one at risk for Type II diabetes)
• Cardiac dysfunction (heart attack, heart failure, or enlarged heart)
• High blood pressure
• Goiter (enlarged thyroid gland)
• Sleep apnea
• Tiredness
• Menstrual disorders (irregular bleeding; absence of periods)
• Decreased libido (low sex drive)
• Vision problems (tunnel vision; vision loss)
• Psychological problems (depression; anxiety)

In children with gigantism, the main symptom is increased linear growth (height) causing extremely tall stature. This can also be associated with obesity, increased head size (macrocephaly) and a prominent forehead (also called frontal bossing).

Diagnostic Tests

GH stimulates the production of another chemical called insulin-like growth factor-1 (IGF-1) by the liver and by many body tissues. Because of the link between excess GH and excess IGF-1, measuring the level of IGF-1 in the blood is an effective screening test for GH excess. Another diagnostic test is measuring GH during an oral glucose tolerance test. Still another test is a magnetic resonance imaging (MRI) scan of the pituitary and hypothalamus. An MRI can determine whether a tumor is the cause of the excess hormone secretion.

Sometimes tests confirm that a patient has GH excess, but the MRI shows no obvious hypothalamus or pituitary gland tumor. In this case, studies are undertaken to find another type of tumor in a body organ which produces a neurohormone, growth hormone-releasing hormone, normally produced by the hypothalamus. This ectopic hormone production has the capacity to stimulate the excessive release of growth hormone by the pituitary gland.

Growth Hormone Deficiency : Signs and Symptoms

Children. Most children with GHD grow less than two inches per year, whereas children with normal GH usually grow at least two inches annually. Some children with congenital GHD may grow normally until age two or three, but then their growth rate slows. Others may have a slow growth starting soon after birth.

Some children with GHD have extra fat in the abdomen and face. Their blood sugar levels also may be low. They may experience emotional distress because of their appearance, which differs from that of other children their own age. As adolescents, they may be slow to show signs of sexual maturity.

A primary care physician or pediatrician who suspects a child has GHD on the basis of a persistently below average growth rate with no other identifiable cause, should refer the patient to a pediatric endocrinologist for evaluation.

Adults. Adults with GHD fall into two general categories. Some individuals may have had GHD as a child and continue to have the deficiency. Other individuals may have acquired the deficiency after reaching maturity. The consequences of GHD in adults result from a lack of both GH and IGF-1.

The disorder has several possible symptoms in adults:

• Increased body fat (particularly at the waist and in the face)
• Decreased muscle and bone mass
• Thinning skin with fine wrinkles
• Poor sweating or impaired temperature regulation
• Reduced strength and endurance
• Low energy level
• Decreased well-being (moodiness, mild depression)
• Loss of interest in sex
• Poor sleep
• Higher cholesterol levels, especially LDL (“bad”) cholesterol
• Overproduction of insulin (a hormone produced by the pancreas that regulates the levels of sugar in the blood), resulting from overweight

Diagnostic Tests

Although there is no gold standard for the diagnosis of GHD, GH stimulation tests are commonly used in patients who have symptoms, low IGF-1, and normal levels of other pituitary hormones. Because the pituitary gland secretes GH in bursts throughout the 24 hours, random measurements of levels in the blood are useless.

In applying a growth hormone stimulation test, if a patient’s GH levels in blood are outside the lower limits of a normal response, it is likely the patient has GHD. GH stimulation tests are not perfect, however, and some endocrinologists question their utility. Some children with putative GHD have stimulated GH concentrations in blood that are above the arbitrary cutoff values for the tests.

Although no stimulation test is perfect, the insulin tolerance test tends to be an excellent predictor of GHD. The test involves giving the patient insulin after an overnight fast to lower their blood sugar. Failure to respond to insulin-induced hypoglycemia is a strong indication of GHD. (This test is not appropriate for patients who have seizures or coronary artery disease.)

A good alternative to the insulin tolerance test is a stimulation test that uses GH-releasing hormone together with arginine — an amino acid necessary for the release of GH. This test is inappropriate for patients with liver or kidney disease.