Growth Hormone Deficiency

What is growth hormone deficiency?

Growth hormone deficiency (GHD) is a rare condition in which the body does not make enough growth hormone (GH). GH is made by the pituitary gland, a small organ at the base of the brain.

In children, GH is essential for normal growth, muscle and bone strength, and distribution of body fat. It also helps control glucose (sugar) and lipid (fat) levels in the body. Without enough GH, a child is likely to grow slowly and be much shorter than other children of the same age and gender.

It’s important for parents to know that there are many reasons for slow growth and below-average height in children. At times, slow growth is normal and temporary, such as right before puberty starts. A pediatric endocrinologist (children’s hormone specialist) or primary care doctor can help find out why a child is growing slowly. Most children with GHD grow less than two inches (5 centimeters) each year.

What are the signs of GHD?

• Slowed growth in height in infants, children, or adolescents (teenagers) 
• Low blood glucose levels (in infants and toddlers with severe GHD and ACTH deficiency) 
• A very small penis (in newborn males with severe GHD and LH/FSH deficiency) 

What causes GHD?

Some children are born with GHD. Others develop it after birth due to a brain injury, a tumor, or radiation treatment to the head. For some children, doctors can find no cause.

How is GHD diagnosed?

Your doctor will review your child’s medical history and growth charts, and look for signs of GHD and other conditions that affect growth. Your doctor may do tests to help find the cause of slow growth. These include:

• An X-ray of the hand to check bone growth (bone age) and assess growth potential
• Blood tests and other laboratory tests to rule out other conditions that affect growth
• Specific tests for GHD include
• Insulin-like growth factor (IGF-1) and insulin-like growth factor binding protein-3 (IGFBP-3)
• GH stimulation test. The child is given medicines that stimulate the pituitary to release GH. Then, if GH levels in the blood don’t rise to a certain level, it can mean the pituitary is not making enough GH.
• Magnetic resonance image (MRI). An MRI (imaging test) of the head will look for a problem with the pituitary or the brain.

How is a child with GHD treated?

Children with GHD receive treatment with daily injections of synthetic (manufactured) human GH, a prescription medicine. The GH, given at home, is injected under the skin. Initially monitoring is preformed with serum IGF-1 levels. After 3-6 months of treatment, the growth response to GH therapy is monitored. 

The best results occur when GHD is diagnosed and treated early. In some children, GH can lead to four inches (10 centimeters) of growth during the first year of treatment. Others grow less, but usually faster than without treatment. Some children need treatment until adolescence; others need it into adulthood.

What are the side effects of GH therapy?

Mild to moderate side effects are uncommon. They include:

• Headaches
• Muscle or joint pain
• Mildly under active thyroid gland
• Swelling of hands and feet
• Worsening curvature of the spine (scoliosis)

Rare but serious side effects include:

• Severe headache with vision problems
• A hip problem, when the top of the thigh bone slips out of place
• Inflamed pancreas (pancreatitis)

For most children, the benefits of taking GH outweigh the risks.

What can you do to help your child with GHD?

You can help your child get the best care for GHD by taking these steps:

• Call the doctor if you have questions about treatment.
• Follow directions carefully when giving GH and other prescription medicines to your child.
• Tell all of your child’s doctors that your child takes GH.
• Be sure your child gets frequent checkups.
• Get counseling for your child if you see signs of poor self-esteem or sadness that could be related to being smaller than peers.

Questions to ask your doctor

• What should my child’s height be at this age?
• Why is my child growing slowly?
• Does my child need treatment for GHD?
• If so, how and when do I give my child the shots?
• Should we see a pediatric endocrinologist?