Growth hormone (GH) is a protein hormone produced by the anterior pituitary growth hormone cells, which is necessary for normal growth and plays an important role in the function of the heart, kidneys, skin, internal organs, bones, muscles, gonads and other growth and development, as well as in the metabolism of sugar, fat and protein. Although growth hormone deficiency is not as life-threatening as diabetes caused by insulin deficiency, it can cause a series of abnormalities such as short stature, osteoporosis, poor muscle development, susceptibility to cardiovascular disease, poor sexual development, and easy aging.
In 1958, GH extracted from the pituitary gland of a recently deceased person was clinically applied to treat patients with growth hormone deficiency (GHD). Although the efficacy was remarkable, it was not easy to obtain, the yield was very small, and the causes of death varied from person to person, and there was a risk of infection with serious infectious diseases, which could not meet the needs of patient treatment. It was not until 1985 that human growth hormone (rhGH) made by recombinant gene technology was officially marketed and better used in clinical practice. Recombinant human growth hormone (rhGH) has been widely used in the treatment of pituitary GHD with better efficacy and experience. With the continuous research on the causes of short stature, the application of rhGH has been extended to the treatment of non-GHD short stature, such as congenital ovarian hypoplasia (Turner syndrome), small for gestational age children, Prader-Willi syndrome, chronic renal failure and adjuvant therapy for precocious puberty.
The U.S. Food and Drug Administration (FDA), the world’s most stringent drug review agency, approved growth hormone indications: 1985 childhood growth hormone deficiency (GHD); 1993 chronic renal insufficiency before kidney transplantation; 1996 HIV infection-related failure syndrome; 1996 Turner syndrome Short stature; 1997 GHD replacement therapy in adults; 2000 Prader-Willi syndrome; 2001 Small for Gestational Age (SGA); 2003 Idiopathic Short Stature (ISS); 2003 Short Bowel Syndrome; 2006 SHOX gene deficiency in children without GHD; In recent years, rhGH has also been found to have outstanding results in anti-aging and weight loss treatment. The efficacy of rhGH in anti-aging and weight loss treatment has also been found in recent years.
Since GH is a protein with a molecular weight of about 22 KD, if taken orally, it is broken down. After decomposition, it is no longer GH, and even if it is taken orally without being decomposed by certain methods, the large molecule cannot be absorbed through the gastrointestinal tract. Similar to the insulin used by diabetics, it is a human dream to make an oral preparation, but it is difficult to realize in the near future. At present, rhGH is used in a similar way to insulin, and the lyophilized powder is dissolved by applying the injection water distributed by the manufacturer, and then injected by applying insulin needle (BD needle), once a night about 1 hour before bedtime. The water can also be injected directly with a general BD needle, or possibly with a “Novo Pen”. Because the BD needle is very fine, than the acupuncture needles used in Chinese medicine is also fine, fine to a certain extent the pain is not obvious. Normal people usually have very little GH content in the blood, only at night during deep sleep will appear several peaks, to determine whether GH deficiency, only the usual value can not reflect the GH level, must be through drug stimulation test (stimulation test), and a small amount of blood collection (generally used intravenous needle, can reduce the pain of multiple venipuncture), in order to measure the peak secretion of growth hormone. The peak value is the criterion to determine whether GH is deficient or not. The peak value of GH is very low, but the peak value can be more than 50 times the usual value, and the half-life (the time required for the concentration in the blood to drop by half) is very short, usually only about 20 minutes, therefore, GH deficiency will not cause too much GH or affect its own GH secretion after the application of therapeutic doses. The average peak in mid-puberty is 22.4ng/ml, which is more than twice the adult value. In the middle of puberty, the total amount of GH secreted in a day can reach 60ug/kg/day, which is more than three times of the adult value. The normal treatment amount, and the total daily secretion of normal people still in a certain gap, but in the appropriate time application, and its own secretion peak overlap, it can reach a more normal secretion peak, play an effective improvement of lifelong high role and normal metabolism required for GH peak.
In 2003, the FDA approved the use of rhGH for the treatment of idiopathic short stature (ISS) in non-GH deficiency. Since it is officially approved for use in non-GH deficient individuals, it must have at least a good safety and efficacy profile, one or the other being essential. The etiology of ISS is not clear and may be due to a combination of underlying factors. There may be insufficient or disturbed total GH secretion and poor GH activity; there may be GH receptor abnormalities, mutations or receptor insensitivity; there may be a relative deficiency of insulin-like growth factor-1 (IGF-1), etc. With the improved level of biochemical and genetic testing techniques, the etiology of ISS may be gradually found in the future. Other indications: 1. chronic renal failure; 2. liver failure; 3. dilated cardiomyopathy; 4. surgical field: burns, severe trauma, post-surgery, total intravenous nutrition, etc.; 5. improving immune function; 6. others: anti-aging, certain infertility. Dosage and course of treatment: dosage and course of treatment vary depending on the type of disease, age and bone age at the time of treatment. Compared with foreign countries, the overall situation in China is that the dosage is relatively small and the course of treatment is short.
Diseases in which GH should be contraindicated or used with caution: active tumors, diabetes mellitus with severe complications, Down syndrome, Bloom syndrome, megaloblastic anemia, etc.