A thin and small boy was brought to the endocrinologist by his anxious mother. It turned out that the boy was 9 years old, but his height was only 1.1 meters, and he only grew two or three centimeters a year, always the shortest one in his class. The doctor gave the boy a thorough examination and diagnosed him with “growth hormone deficiency” and gave him recombinant human growth hormone (r-hGH) treatment. Soon, the boy began to grow in size, eating significantly more, and becoming sturdier. In the first year of treatment, the boy grew a total of 14 cm, catching up with the average for boys in his class.
This is an ordinary but typical case. Children’s growth and development is an issue that most parents today pay close attention to, and everyone wants their children to have an ideal height. However, there are some parents whose children are far behind their peers in height, but they blindly believe that their children are just “late growing”, and as a result, the best time for treatment is delayed. For many children with growth retardation, timely and scientific application of growth hormone therapy is the last resort when non-pharmaceutical measures such as exercise, nutrition and sleep are ineffective. Once the epiphysis closes, the child will never have a chance to grow taller.
Growth hormone is secreted by the pituitary gland, and its secretion in normal people is accompanied by a lifetime. As the name implies, growth hormone has the function of promoting human growth and height. In addition, it has other effects that people are not familiar with, such as having an important impact on a person’s bone density, fat and muscle composition, blood lipid and blood sugar metabolism.
The effects of growth hormone on a person’s life can be divided into three stages.
1. before puberty, when growth hormone plays a growth-aiding role
2. during puberty, together with sex hormones, it plays a regulatory role in the sexual maturation of a person.
3. In adulthood, growth hormone still plays an important role, and if it is lacking, a person will show no energy, muscle weakness, osteoporosis, obesity and aging.
Therefore, growth hormone is also supplemented in the treatment of certain endocrine diseases in adults. Currently, genetically recombinant human growth hormone is most commonly used as a drug replacement therapy to help the growth and development of children before puberty. This is because during this period, if growth hormone is deficient and the child is clearly not growing, it is easy for parents to detect and pay attention and intervene.
For children who are short and need treatment, growth hormone therapy can be applied until their epiphyses close. Once the epiphysis is closed, it must not be used, otherwise it will become another endocrine disease – acromegaly. This is a disease caused by excessive secretion of growth hormone. In addition, it is important to note that growth hormone therapy is not suitable when suffering from certain diseases, such as malignant tumors, diabetes and the active stage of some diseases. Also, children with tumors such as leukemia, if the tumor is still in the active stage, or if the disease has not been controlled and stabilized for a long time (within six months), it is also not suitable to use the drug to help growth.
Since growth hormone treatment takes a long time, and some children may need to use it for several years, it is also a concern for parents as to what adverse effects growth hormone treatment can cause. The European Society of Pediatric Endocrinology officially declared in 1993, after 30 years of extensive clinical observation, that r-hGH has a good safety profile when applied to conventional replacement therapy. However, clinically, doctors still confide some precautions to parents.
The most common adverse reaction to growth hormone is allergic reaction, and if it is more serious, treatment should be stopped. There is also benign intracranial hypertension, which is usually treated by reducing the dose or temporarily stopping the drug, after which most people can be relieved. During the treatment process, hypothyroidism may occur in a few patients, which should be corrected in time to avoid affecting the efficacy of growth hormone, and blood T3 and T4 levels (indicators reflecting thyroid function) should be checked regularly. During the course of treatment, if the child grows too fast, has too much daily activity, and moves in an inappropriate manner, dislocation of the acetabular joint may occur in individual children.
Numerous studies have concluded that there is no evidence that long-term use of r-hGH promotes leukemia, tumors and diabetes mellitus. In clinical practice, there are very few cases of elevated blood glucose due to the use of growth hormone alone. Xueyan Wu emphasized that children with Turner syndrome, who have their own glucose metabolism problems, are prone to elevated blood glucose when high doses of growth hormone are used.
As with the treatment of other diseases, the effect of growth hormone treatment varies from person to person and from disease to disease. Some children with growth hormone deficiency can grow about 14 cm taller in the first year after treatment. In general, children with growth hormone deficiency can grow an average of 10-12 cm in height in the first year after treatment with growth hormone; individual children with non-growth hormone deficiency can experience unsatisfactory height growth after treatment. So what should parents do to make growth hormone therapy more effective?
There are many factors that affect the effectiveness of growth hormone therapy, the main one being the child’s own responsiveness and sensitivity to growth hormone. This responsiveness to growth hormone is innate and genetically influenced, which is why we have a formula for calculating a child’s lifetime height based on the parents’ height. There are, of course, influences that can be improved, such as the influence of other hormones. A general growth hormone deficiency is commonly accompanied by a low level of recessive thyroid function. If the thyroid hormone is deficient, it can affect the effectiveness of growth hormone therapy. Therefore, thyroid function needs to be rechecked in 2-3 months of treatment with growth hormone, and if it is low, thyroxine supplementation is required.
Normal human growth hormone is secreted in pulses, which usually starts to appear at night, about 90 minutes after the child is asleep, and about 90 minutes is a cycle; the secretion of growth hormone will also be stimulated after exercise in general. Therefore, during growth hormone treatment, we need to simulate the secretion characteristics of the human body’s own growth hormone and inject it subcutaneously at night before going to sleep.
The possible reasons for the poor efficacy of growth hormone therapy are.
1. poor patient compliance with treatment.
2. poor preparation or injection technique, or inadequate dose.
3. the effect of subclinical hypothyroidism.
4. failure to develop good lifestyle habits while using medication, such as partial eating and inactivity.
In conclusion, following medical advice, using appropriate doses, correct injection methods and drug storage, regular review, ensuring nutritional balance, and ensuring adequate sleep and exercise are the prerequisites for the best results of treatment.