Height measurement: It is necessary to measure the height of patients with either short stature or precocious puberty every month after treatment, and since the change in height within a month is small, it is necessary to measure it as accurately as possible. Accurate height measurement needs to pay attention to “four similarities”: ① the same time, because after standing or sitting up, the vertebral space of the human spine will be compressed, so the height will be different in the morning and the evening, and the measurement will be comparable only at the same time; ② the same measuring tape; ③ the same measurer, different people, the tightness of the tape card on the head will be different; ④ the child the same method of standing (requiring shoes off, heels, hips, shoulders and head all against the wall, chest up, stomach in, waist as straight as possible, eyes level, head not too tilted, otherwise the highest point of the head can not be measured). If you measure at home, you can put a piece of paper on the wall, and draw a line on the paper after each measurement. It is not necessary to measure the specific height of each measurement, but only to distinguish the difference with the previous month. When measuring at home must pay attention to the ruler and the floor level, you need to use a right angle triangle ruler, or use a hard book, one side against the wall, the other side and the floor level. Parents often respond, “My child grew by 2cm last month, but he hasn’t grown at all this month?” The main reason is that it is still related to the measurement error. After a longer treatment time, the growth can be averaged over several months (note: usually do not measure height too often, in general, height and weight can be measured once a month (and it is recommended to keep good records), otherwise it is easy to cause psychological pressure to the child, too much psychological pressure is not conducive to growth). Since the drug dose is generally calculated according to body weight, if the weight change exceeds 10%, it may be necessary to adjust the drug dose (during the six-month review period, the body weight should be controlled appropriately, and the change should not exceed 10% as much as possible).
Growth hormone treatment review time and items: For those who apply growth hormone treatment, after 3 months of treatment, thyroid hormone (mainly FT3, FT4 and TSH) and fasting blood sugar need to be reviewed. Since most of the treated patients are dwarf patients, the growth rate was too slow in the past and the thyroxine requirement was low. After the growth was accelerated significantly, the thyroxine requirement increased and a few people may cause a relative deficiency of thyroxine. Insufficient thyroxine requires oral levothyroxine tablets for a short period of time, otherwise the efficacy of the growth hormone will be affected (there are also a few cases of slightly high thyroxine due to over-regulation of thyroxine, at this time, as long as the TSH is not low, there is also generally no need to deal with it, and continued use of growth hormone will often automatically drop to normal). In addition to thyroxine and blood glucose, bone age and insulin-like growth factor-1 (IGF-1) and insulin-like growth factor binding protein-3 (IGFBP3) should be checked when the IGF test is repeated in about six months (since the IGF test is to understand the situation after the medication, it is necessary to continue the medication as much as possible when the test is repeated, otherwise the reliability of the results will be affected. And the IGF test results may vary greatly from hospital to hospital, and there are also some hospitals where the reliability of the reagents is not necessarily high.
The latest information from abroad shows that the treatment effect is significantly better than the traditional fixed dose by adjusting the dose of growth hormone according to the IGF results at the right time. Subsequent review, usually once every six months is sufficient, and review at 1 year of treatment, preferably also review liver and kidney function (can be done together with blood sugar).
Growth hormone stimulation test, as long as it is done correctly and relatively standardized, regardless of treatment or not, is in principle not necessary to be done again, except for very rare and special cases. Therefore, it is not necessary to do the growth hormone provocation test again when reviewing after treatment.
Growth hormone dose adjustment: Growth hormone generally does not need to be adjusted within a short period of time, and weight changes not exceeding 10% generally do not need to be adjusted, and even if adjusted, it is not only based on growth rate or weight. It is also necessary to consider different etiologies, the results of the growth hormone provocation test before the initial dose, the development of youth, the size of the bone age, and especially the results of the IGF-1 and IGFBP-3 review. Regular review is also necessary! Although the effect of treatment is important, the safety of medication is more important! The dose of growth factor has a wide range. For those with small bone age and sufficient treatment time, we generally start with a smaller dose within the normal range, if the small dose has a better effect, the cost is relatively low and the side effects are less likely to occur. For children with older bones and limited treatment time, generally start with a medium or large dose of the normal range, because of the limited time and slow observation may affect the final treatment effect.
Growth hormone discontinuation index: For those who start treatment at a younger age, the treatment can be temporarily stopped for a period of time when the height reaches or slightly exceeds the height of the same age (usually takes 2~3 years or longer), and then used again when the height is significantly lower than that of the same age. For those who are older in bone age, due to the limited treatment time, the indicator for stopping the drug is to stop when the monthly growth rate is less than 4mm for three consecutive months (although the application may still improve 1 or 2mm per month, but the available time is already very little and has no substantial significance). However, for those whose height has approached normal adult height during the period of use, discontinuation of the drug can also be considered, but a detailed assessment of whether the treatment objective has been achieved is needed before discontinuing the drug.