Although growth hormone is currently the most effective drug for the treatment of short stature, but clinically growth hormone cannot be applied arbitrarily, not all patients with short stature are suitable for growth hormone treatment, the relevant examinations and precautions that should be carried out before applying growth hormone are summarized below.
I. Relevant examinations that must be performed before applying growth hormone.
1.Bone age.
2. fasting glucose, insulin, IGF-1, liver and kidney function, A function, hepatitis B, blood and urine routine, GH stimulation test.
3, pituitary MRI.
4.Girls with short stature should have pelvic ultrasound examination and karyotype analysis if necessary (boys with particularly short stature should have chromosome examination).
Second, the indications for growth hormone application
1.Growth hormone deficiency.
2.Less than fetal age children.
3, idiopathic dwarfism (familial dwarfism, somatic pubertal growth delay).
4, Turner syndrome (congenital ovarian hypoplasia)
5, Noonan syndrome.
6. Chronic renal insufficiency before transplantation.
III. Time of starting growth hormone treatment
The time to start growth hormone treatment differs for different causes of short stature.
1.Growth hormone deficiency: around 4 years old.
2.Less-than-fetal-age children: after 4 years of age
3. idiopathic dwarfism: after the age of 5 years
4.Turner syndrome: growth hormone therapy can be applied after 2 years of age.
Dose of growth hormone treatment
Growth hormone therapy can effectively increase the growth rate of children with short stature and improve their adult height. The therapeutic effect has a dose-dependent effect and there are individual differences. The starting amount varies from disease to disease. The general dose is 0.1-0.2 U/kg/day, and the maximum amount should not exceed 0.2 U/kg/day. During the treatment process, the dose should be adjusted according to the growth situation and biochemical test results at the right time.
V. Dose adjustment during growth hormone treatment
Dose adjustment should be made according to body weight, treatment response, sexual development status and serum IGF-1 level. If IGF-1 is higher than the normal range, especially if it is consistently higher than 2.5 SD, dose reduction or discontinuation can be considered.
Evaluation of growth hormone treatment effect
Indicators of effective response of growth hormone treatment in the first year.
1.Increase in height SDS by more than 0.3-0.5.
2.Growth rate increase >3cm/year compared with that before treatment.
3.Growth rate SDS>1.
VII. Course of growth hormone application
The course of growth hormone treatment varies depending on the condition. The younger the age of starting treatment, the better the efficacy; the longer the treatment time, the more significant the improvement of adult height. In order to improve adult height, it should be applied for at least one year.
VIII. Monitoring during growth hormone treatment
Children who apply growth hormone should be monitored regularly for the effect and safety of treatment, mainly monitoring the following indicators.
1.Height, weight and sexual development: check once every 3 months.
2. fasting glucose, insulin, thyroid function: once every 3 months.
3.Serum IGF-1, IGFBP3: once every 3-6 months.
4. liver and kidney function, cortisol, glycated hemoglobin: once every 6-12 months.
5. Bone age: once every 6-12 months.
Adverse effects of growth hormone therapy
In general, the application of growth hormone is safe, and the overall incidence of adverse reactions is less than 3%. The main adverse reactions are: benign intracranial hypertension, effects of glucose metabolism, hypothyroidism, and skeletal changes.
Long-term growth hormone therapy can reduce insulin sensitivity and increase insulin resistance, and some children develop impaired fasting glucose and impaired glucose tolerance, but they are mostly temporary and reversible, and do not increase the prevalence of type 1 diabetes.
According to the results of current studies, growth hormone therapy does not increase the risk of new malignant tumors (such as leukemia, central nervous system tumors or extracranial malignant tumors) in patients without tumors; in patients with cured tumors, growth hormone therapy does not increase the risk of tumor recurrence and does not affect the recurrence of brain tumors, craniopharyngioma or leukemia.
X. Conditions in which growth hormone is prohibited
Growth hormone should be prohibited for active tumor, active psychiatric disease, severe obesity, uncontrolled diabetes mellitus, uncontrolled severe obstructive sleep apnea, Bloom syndrome, Fanconi syndrome, congenital stupidity, etc. It should be used with caution for mixed gonadal dysplasia and neurofibromatosis, etc. The application of growth hormone is not advocated for intracranial tumors within 2 years after radiotherapy.
When to stop using growth hormone
Growth hormone therapy should be discontinued in the following cases.
1.After treatment, the height is greater than the normal adult height-2SD.
2.Approaching adult height, i.e. growth rate less than 2cm/year.
3.Bone age is greater than 16 years old for boys and 14 years old for girls.