It is necessary to measure height every month after treatment for both short stature and precocious puberty, and since the change in height within a month is small, it is necessary to measure it as accurately as possible.
To measure height accurately, we need to pay attention to “four similarities”.
①The same time, because after standing or sitting up, the intervertebral space of the 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 ruler card in the head of the tightness will be different;
④ the same standing method for children (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 draw a specific height for 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 rate of several months can be averaged (Note: usually do not measure height too often, in general, height and weight can be measured once a month, otherwise it is easy to cause psychological pressure on the child, too much psychological pressure is not conducive to growth).
As the drug dose is generally calculated according to body weight, if the weight change exceeds 10%, it is possible that the drug dose needs to be adjusted (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, thyroxine (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 growth hormone will be affected (there are also a few people who have slightly high thyroxine due to over-regulation of thyroxine, at this time, as long as TSH is not low, it is also generally not necessary 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 whose reagents are not necessarily reliable, so if the initial diagnosis is made in our hospital, it is recommended to come to our hospital for IGF review).
IGF review is an important indicator of both medication safety and growth hormone dose adjustment. The latest information from abroad shows that the treatment effect is significantly better than the traditional fixed dose if the dose of growth hormone is adjusted according to the IGF result at the right time. Subsequent review, generally once every six months is sufficient, and review at 1 year of treatment, it is best to 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, the principle is that it does not need 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 dosing, pubertal development, bone age size, and especially the results of 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, we for the smaller bone age, treatment time is more abundant, generally from the normal range of smaller doses to start, if the small dose effect is better, the cost is relatively lower, side effects are also less appear, if the effect is not satisfactory, and then consider adjusting the dose. 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 indicator: 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, due to the limited treatment time, the indicator of 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, there is no substantial meaning).
However, for those whose height has been close to normal adult height during the period of use, discontinuation of the drug can also be considered, but a detailed assessment of whether the therapeutic objectives have been achieved is needed before discontinuing the drug.
GnRHa treatment review program and dosage adjustment: Since the dosage of GnRHa treatment in patients with precocious puberty is a difficult issue, it needs to be individualized, i.e., the dosage may be different for each person, at different times. Especially the first six months to one year of treatment needs to be reviewed from time to time. The height growth, control of sexual development, ultrasound (for girls, for boys only testicular size), sex hormone levels [generally sex hormone six, which need to include at least LH, FSH and E2 (female) or T (male)] should be reviewed 2 months and 6 months after treatment, and the GnRH stimulation test should be reviewed every 6 months, and the bone age should be reviewed every 6 months so that the dosage can be adjusted at the right time.
If the dose is too high, the growth will be too slow and will not help much to improve the adult height, and if the dose is too low, it will be difficult to control during puberty and will not achieve the treatment purpose. According to the guidelines of precocious puberty, it is better to evaluate the bone age in detail, because it is difficult to identify the growth of bone age without detailed evaluation because of the short interval, which is not conducive to dose adjustment. The dose adjustment of GnRHa is mainly in the first six months, and after six months, if there are no special changes, it is usually once every six months, and the review items are the same as the review at six months.
At present, in GnRHa treatment for more than two months when the review, from time to time, using the method of checking the sex hormone about 1 hour after the injection of GnRHa, so equivalent to a simple stimulation test (the first dose has been enhanced, injection of the third injection is often less than 1.5 months, generally do not check the value of one hour after the injection), unless the treatment is not smooth, when the review, generally rarely do the standard GnRH stimulation test.
GnRHa discontinuation indicators: application is generally not less than two years, in the bone age and age, and reached or close to the age of normal sexual development, the predicted height slightly higher than the target height (generally to be 2 ~ 3cm higher) can be considered to stop the drug. For girls, discontinuation is generally considered only when the bone age is not too great, the age is greater than 10 years old, and the height is around 150 CM. This is because after discontinuing the drug, there is still 2~3 months of slower bone growth time, but after that there is often 2~4 months of faster bone growth time, and the later rapid bone growth may lower the predicted height.
Alternatively, the drug may be discontinued when the bone age is greater than 13.5 years for girls and 14.5 years for boys, at which point even combined use of growth hormone may not be effective in increasing lifetime height, but growth hormone may be considered for continued use.
For pseudo or partial precocious puberty oral Chinese medicine, generally is every 3 months to review ultrasound, sex hormones (generally check sex hormone six, at least need to include LH, FSH and E2), if necessary, review GnRH stimulation test. Bone age should be rechecked in six months.
Precautions after injection of recombinant human growth hormone: Since growth hormone is a hormone normally secreted by the human body every day, rhGH is exactly the same as the body’s own secreted growth hormone, there is no need to associate any abnormalities that occur with rhGH during the medication period. Growth hormone also will not promote sexual development or promote bone age growth as some people think (although growth hormone deficient people may originally have small bone age, after applying growth hormone to make it normal, there is a possibility of transition to normal bone age), otherwise it will not be used to improve lifetime height.
If you are more ill, consider stopping the use for a few days as your own growth will be affected. Usually there is no big problem to stop using it for a few days in special cases. Since normal people also secrete growth hormone every day, the application of general medications or preventive vaccinations, etc., during the use of the drug is not affected.
GnRHa is an amino acid replacement of normal human gonadotropin-releasing hormone (GnRH, a 10-peptide), making it bind more strongly to the gonadotropin-releasing hormone receptor on the pituitary gland without acting as a gonadotropin-releasing hormone to inhibit pubertal growth.
Overall safety is good. Some side effects on the instruction are mainly for adults, because the adult sex hormone level is high, and the sudden suppression will cause a series of side effects such as osteoporosis and other sex hormone decline. During the period of medication, the application of general drugs or vaccination is not affected in case of illness, and the same applies to oral Chinese medicine in case of pseudoprecocious puberty.