I. Under what circumstances do CPP patients need combined GH therapy?
In the treatment of precocious puberty, GH therapy is added or given at the same time in children with growth deceleration <5cm below the normal rate, or in children with older skeletal age of BA>11y in females and BA>12y in males, and lower basal height; -2SD or
Second, the timing of growth hormone treatment for CPP?
If the bone age is >11.5 for females and >13y for males, GH can be used directly and GnRHa treatment is no longer necessary. The timing of drug use is different for different bone ages;
1, the bone age is not big, as far as possible in GnRHa treatment for about six months, after the GnRHa dose is adjusted to the maintenance amount, and then consider the combination of growth factors, because the dose adjustment, height growth is also an important reference indicator.
2, for bone age older, the use of GnRHa has been difficult to improve the lifelong height, the use of GnRHa purpose has been mainly to properly inhibit bone age growth, so that growth hormone has more treatable time, GnRHa use more than 2 months, you can combine growth hormone therapy.
3, for those whose bone age is close to the inappropriate use of GnRHa, parents must be informed in advance that it is difficult to improve the lifetime height with GnRHa alone, if you want to improve the lifetime height, you can consider using growth hormone alone, you can also consider combined therapy, only the cost of combined therapy is higher. Parents need to be informed in advance that there are other treatment options available.
Third, the dangers of not treating precocious puberty?
1, depending on the needs and psychological tolerance of parents and affected children, the degree of acceptance of lifelong height, the parents are not high, the rapid progress of sexual development of children informed, the rapid progress of sexual development, epiphysis fast closure, adult lifelong height will not be ideal; if not immediately treated, there is no more room for growth in the future, then by then the use of any method will not help.
2, premature sexual development of children, although the early development of sexual characteristics, but the level of psychological and intellectual development is still the actual age level, premature appearance of sexual characteristics and reproductive organ development will lead to immature children psychological disorders, girls early menarche, but also bring a lot of inconvenience to life, serious even affect reading and learning.
3, premature sexual maturity, and self-protection ability is not enough, may also be more vulnerable to injury.
4.How to correctly understand CPP dwarfism treatment course?
For growth hormone treatment, it mainly depends on the difference between the current height and the height for bone age or the difference between the predicted adult height and the target height. The larger the gap, the longer the treatment time. Three months is the observation period, and six months is the evaluation period to assess the clinical efficacy and whether the treatment plan needs to be modified.
V. When do patients need to be seen again after treatment with growth hormone? What are the items that need to be reviewed? Why do I need a follow-up?
Children treated with GnRHa need to be reviewed monthly after the initial treatment, or every three months for special inconveniences, and every six months for evaluation. The follow-up items include: height, weight, BA, IGF-1, IGF-BP3, blood glucose, insulin, routine blood, annual routine, liver and kidney function, complete set of sex hormones, gonadal ultrasound, HCG.
According to the comprehensive analysis of the above results to decide whether it is necessary to modify the treatment plan, there are some sick children after GnRHa treatment, growth slowed down significantly, the dose can be adjusted, but bone age needs to be suppressed, if the growth is still not satisfactory, then add growth hormone under the dose of control of bone age; if the dose of GnRHa is too large, the height growth is suppressed excessively, which is not conducive to improve the lifetime height, and the dose of GnRHa is too small, the bone age is controlled The dose of GnRHa may be different for different people and different periods, so individualized treatment is necessary. Also monitor the occurrence of adverse reactions.
Six, the efficacy of the patient after the drug assessment?
Three months is the observation period, six months to assess the clinical efficacy, comprehensive assessment of the need to modify the treatment plan. The evaluation of efficacy varies with age; a growth of 1.5 cm in three months indicates efficacy, and an average growth of 0.6 cm per month in six months indicates significant efficacy.
How do you think about the safety of the growth hormone treatment process?
1. Growth hormone is a very safe drug, first of all, in terms of the history of its use. It has been used in foreign countries since the 1950s and 1960s, but in our country, it started to be used only after 85 years. 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 does not cause tumor itself. 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. That’s why we will do so many tests before you use the medicine, don’t mind the trouble, safe use of medicine is the most important.