I. How to treat ISS at different ages?
Patients who are older than 3 years old, whose epiphyses are not closed and who have met the diagnostic criteria for dwarfism are recommended to do IGF-1 generation test first after detailed examination to exclude factors that are not suitable for treatment, such as the presence of physical adverse drug reactions; then, if GH peak in GH excitation test is too high or GH peak is not proportional to IGF-1 value, GH is high while IGF-1 is low, to exclude GH receptor abnormalities in all ISS types may be recommended for growth hormone.
The application of growth hormone may also be recommended to parents for children with suboptimal genetic height to maximize growth potential and reach the high limit of genetic target height (i.e., genetic target height + 6 CM). For children who may have delayed puberty, it is also recommended to use growth hormone first so that the child’s height can first reach the average value of the same age and gender, and then the changes in sexual development and height can be observed to prevent missing the best time for treatment.
Any prepubertal ISS makes it have a catch-up growth, ISS that starts to develop can be combined with GnRHa, and ISS in late adolescence is treated with a high dose to make a final growth sprint to make a lifelong height improvement. If the growth is bad since childhood, the effect of using GH growth will also be almost.
Second, the effect of not treating dwarfism on children?
Since the diagnosis of dwarfism can be made, it means it is pathological and it is not appropriate to have the disease without treatment. If your child is not treated, from the current growth curve, the child’s adult height is XX cm. What do you think of this height for your child? If your child is not treated, his adult height will be too low, which will have a great impact on his future schooling, employment and marriage, etc. Moreover, long-term shortness will have great psychological changes, which may cause low self-esteem and abnormal personality development. If you regret by then, or if your child does not accept the height, there is no turning back at that time, and you cannot do it again.
3. How to correctly understand the treatment course of dwarfism?
For those who have reached the diagnostic standard of dwarfism, the difference between their height and the average height of their peers is generally more than 10cm. The specific time of treatment mainly depends on the degree of your child’s backwardness and sensitivity to growth hormone. In special cases, at least not less than 1 year, the time is too short to be of substantial significance, and a long course of treatment is better than a short course of treatment.
If you are only going to treat for 3-6 months then you might as well invest that money in your child’s education. We need to achieve certain goals in everything we do, and it is better to catch up with the average height of children of the same age before we consider stopping for a little while, after which there is a possibility to treat again. Maintaining a more normal height will help to reduce the negative psychological effects caused by dwarfism.
4. When should patients who have been treated with growth hormone have a follow-up visit? What are the items that need to be reviewed? Why do I need a follow-up?
It depends on the age of the patient. Generally speaking, the first month should be a follow-up visit to determine whether the parents’ injection method is correct, whether the child tolerates it, whether the drug extraction is correct, and to do some specific laboratory tests such as nail function and IGF-1 to see the compliance with the drug and early adverse reactions. The field is generally three months to review, parents trust high if soon to review will have an opinion. Review items;
1.Height and weight (depending on the child’s growth);
2, IGF-1, IGF-BP3, IGF-BP3 is not very instructive, but the ratio of the two is meaningful (the response to GH, safety);
3, and free T4 (to see the thyroid function).
4. Bone age is measured once every six months. Bring your previous test results with you to your follow-up appointment, as the items may not be the same each time. The purpose of the follow-up is twofold, one is that the doctor wants to know whether the child has grown taller or not, that is, whether the medicine is effective for your child. The child’s weight is gradually increasing, and the dosage of the medication should be adjusted. If the previous dose is used, the effect will not be good.
The second thing is to monitor whether it is safe, we want the child to grow taller in a safe way, this is the most important thing. The follow-up is not very complicated, usually once every 3 months, you can come once in the winter and once in the summer, and then choose one day in each semester to come back for a follow-up.
V. What is the efficacy assessment of patients after medication?
Experience over the years has shown that different ages, bone age, developmental level, nutritional status and family genetic height affect the efficacy of children, so the efficacy of each child will be different. Don’t be in a hurry to see the effect of the treatment, growth hormone is a panacea, but the effect of the treatment will only be known after 3 months of observation and testing. 3 months is the shortest course of observation, and the bone age will be reviewed every 6 months, then the adult height prediction before and after the treatment can be compared and the size of the difference between the current height and that of children of the same age can be evaluated.
The average growth rate for a normal child before the age of 12 is 5-7 cm per year. There is no significant relationship between the growth during GH application and the season, and the effect is not better in the spring than in the summer.
VI. How do you think about the safety of growth hormone treatment?
1. Growth hormone is a very safe drug, first of all, in terms of the history of its use. Foreign countries started to use it as early as the 50s and 60s, but our country started to use it only after 85 years. Whether it is used early or late, we are all very concerned about its side effects. From some foreign clinical studies or some domestic clinical applications, the overall is very safe, so far no serious adverse reactions reported.
2, our body itself will also secrete growth hormone, the main role of this hormone is to promote the growth and metabolism of our body. If growth hormone deficiency is not replenished in time, there will be many hazards, which will not only cause shortage, but also cause osteoporosis, muscle and gonadal dysplasia, easy aging, high blood lipids, cardiovascular diseases and metabolic abnormalities.
3. In addition, I want to briefly explain a term to you: the so-called “genetic recombination technology” is to make the manufactured things the same as our body’s own. For example, the recombinant growth hormone is the same as our normal human growth hormone, both in structure and principle of action. Therefore, there will not be any major side effects.
4. Regarding the issue of tumor, as a hormone that stimulates the growth of tissues and organs, growth hormone does have a stimulating effect on tumors, but it should be clear that it will not cause tumors. If the child does not have other diseases (mainly tumors), the child will naturally grow taller with growth hormone and it will not cause tumors. But if the child has a tumor in his body, the tumor will grow while the child is on the medication. This is why we will give you so many tests before you use the medicine.
5. The following relevant factors should be understood before growth hormone application.
a. Whether the family has a family history of tumor tendency, especially gastrointestinal tumors.
b. Whether there is diabetes in the family, if so, the child should have a glucose tolerance test.
c. Whether the child has chromosomal abnormalities, if so, careful medication is needed.
d. The child has no hematologic abnormalities and no history of cranial radiation exposure.
e. History of active hepatitis, if any, liver function, hepatitis C, hepatitis E, hepatitis B series should be checked.
f. Whether the child has a history of tumor.
g. Whether the child is using GH antagonists, such as glucocorticoids and cyclophosphamide.