1. How to deal with bleeding at the injection site after the patient has been injected with growth hormone (GH)? Answer: a. When there is only extracutaneous bleeding at the eye of the needle after the syringe is pulled out, it means that the small capillaries of the skin were pierced during the injection; parents and patients should not be nervous because it will not cause any harm to the child’s body and will not affect the efficacy of GH. b. When there is extra- and subcutaneous bleeding at the eye of the needle after the syringe is pulled out, it means that the small capillaries of the skin were pierced during the injection, and the next day a warm towel will be applied for 5-10 min (no hot compress is needed in summer), and the bleeding will disappear in 3-5 consecutive days. c. Because the tip of BD needle is thicker and longer than that of Novo and pen, so there are slightly more cases of bleeding at the injection site when BD needle is injected, but they are relatively rare. d. After the injection, the needle should be pulled out too slowly and bleed easily, so it should be pulled out quickly. 2. How to deal with the patient’s bulge when injecting growth hormone (GH) into the skin? Answer: a. When the patient injects GH, the angle of the needle is too small and the drug is injected into the skin, so there is no need to deal with it and let the skin absorb the drug on its own, which will not affect the efficacy of GH and will not cause harm to the child’s body. b. The correct angle of the needle for GH injection is 45 degrees and the injection is made under the skin. c. The needle enters the skin, but the speed of GH injection is too fast and it is easy to bulge the bag, so each injection takes 3-5 minutes. 3.Mistake the check date of the product manual as the production date? Answer: The product specification check date is not the production date of GH, the production date of GH is on the outer package. 4.When injecting with water, it will cause pain or numbness after injection due to low temperature (common in autumn/winter)? Answer: a. Dozens of minutes before the injection from the refrigerator to avoid the temperature is too low, the injection will feel pain; b. Pain may be caused by the injection speed, should be injected slowly; c. Such as sharp pain due to injection stimulation to the peripheral nerves of the skin, at this time you can pull the needle to change the injection site; d. Before the injection so that the child’s spirit relaxed, can avoid injection pain. 5.After a period of injection, joint pain or myalgia? Answer: a. It may occur after strenuous exercise or sudden increase of exercise, so the amount of exercise should be reduced and moderate exercise can be done. b. It may be caused by the strong physiological effect of sodium and water retention of growth hormone. 6.What is hypothyroidism and how to deal with hypothyroidism during GH treatment? Answer: The diagnosis of subclinical hypothyroidism is made based on laboratory tests, when the patient has not yet shown obvious clinical symptoms or signs. Subclinical hypothyroidism is defined as serum TSH levels exceeding the upper limit of normal (0.45-4.5 mlU/L) while serum free T4 (FT4) concentrations are normal. The need for treatment depends on the specific laboratory values of the child. Treatment is mostly oral levothyroxine sodium, and thyroid function will return to normal after discontinuation of GH. 7.What is the increase in blood sugar during GH treatment? Answer: Generally, it is a transient increase in blood glucose, and it will return to normal soon; if the blood glucose is persistently high, it should be reviewed in hospital, and insulin treatment is needed if the blood glucose is higher than 10mmol/l. If the blood glucose cannot be effectively controlled with more than 150IU/d insulin, GH should be stopped. 8.Oedema occurs during GH treatment? Answer: a. Symptoms of edema: edema of eyelids, face, back of hands, back of feet, lower limbs, intracranial hypertension (such as headache, nausea, vomiting); b. If you can tolerate it, continue to use GH, usually the symptoms disappear within 3-7 days; if you cannot tolerate it, you need to reduce the dose of growth hormone or stop the drug, and resume the drug after the symptoms disappear. 9.Will GH treatment accelerate bone age? Answer: The relevant medical institutions and literature at home and abroad report that GH treatment will not accelerate bone age. 10.Will GH treatment affect the fertility of children? Answer: GH is secreted by the body itself and is necessary for human growth and development; for women in their reproductive years, GH has the effect of promoting ovulation; for men in their reproductive years, GH has the effect of promoting sperm maturation; therefore, GH treatment will not affect fertility. 11.Will GH make the child fat? Answer: GH is a protein, not a glucocorticoid, so it will not cause fat; moreover, it has the effect of local fat reduction. 12.Why should each injection site be two centimeters apart from the previous one when injecting growth hormone? Answer: GH treatment can locally degrade subcutaneous fat, especially the fat in the abdomen and large intestinal omentum is sensitive to catecholamine-mediated lipolysis (e.g. GHD has increased subcutaneous fat, especially abdominal fat accumulation, and GH treatment can make abdominal fat ablate). Growth hormone increases muscle tissue at the same time as fat reduction. Because GH can degrade subcutaneous fat, the injection site should be changed frequently. 13.Will GH treatment cause diabetes? Answer:At present, the relevant literature at home and abroad reports that GH treatment will not cause diabetes. 14.Does GH treatment increase the risk of tumor recurrence? Answer:a. For those whose tumors have been cured, the current data do not indicate that GH treatment will increase the risk of tumor recurrence; b. For those who are suffering from tumors and are receiving treatment, the incidence of original tumors and secondary tumors will increase significantly; c. The risk of new tumors: it will not increase the incidence of new tumors such as leukemia. 15.What is the weight gain of the child after GH treatment? Answer: a. Whether there is occult edema (with occult edema weight gain >500g/w); b. Because GH promotes anabolism, height growth will be accompanied by weight gain. 16.Can GH be vaccinated during treatment? Can the medication be used in the treatment of general medical diseases? Answer: Because GH is secreted by the normal body itself, so GH can be used for vaccination during treatment; GH can also be used during treatment of general medical diseases. 17.Do I need to stop GH during cold treatment? Answer:The general medicine for cold and flu does not affect the efficacy of GH. 18.Is it necessary to use GH for children with asthma or allergic rhinitis? Solution: The dosage of glucocorticoids should be adjusted under the guidance of a professional pediatric endocrinologist. Note: Glucocorticoids are GH antagonist drugs, which will affect the efficacy of GH. 19.Will the efficacy of GH be affected if the child forgets to inject GH one day? Do I have to make up for the missed GH injection? Answer: Forgetting to inject GH once in a while will not affect the efficacy of the treatment, and it is not necessary to make up the missed amount of GH; try to avoid intermittent medication. 20.How long does it take for GH to take effect? Answer: GH treatment takes 3 months as a course of assessment, so GH treatment should be reviewed in the hospital for 3 months for height, weight, nail function and blood glucose, etc., in order to evaluate its efficacy. 21.Cause of poor efficacy of GH treatment? Answer: a. whether the dose of GH is sufficient; b. GH resistance; c. low thyroid function; d. use of glucocorticoids; e. epiphyseal plate closure; f. inaccurate measurement; g. systemic chronic diseases; h. ineffective GH therapy; i . Is the child in residence adhering to G H. 22. How old can GH treatment be discontinued until bone age? Answer: When a girl is 14 years old and a boy is 15-16 years old, the growth rate is less than 2cm/y. To reduce the economic burden of parents, GH can be discontinued. 23.How old can GH not be used? Answer: When a girl is 14 years old and a boy is 15 years old, the growth rate is less than 2cm/y. At this time, the growth space of the child is very limited, so GH treatment is not recommended. 24.Will growth hormone inhibit its own secretion? Answer: For children who cannot secrete or under-secrete growth hormone, exogenous supplementation is needed; secondly, since the amount of supplementation is 0.1-0.15IU/kg/d, which is the smallest effective dose, it will not form a negative feedback effect and inhibit its own GH secretion; 0.15-0.2IU/kg/d will not inhibit its own GH secretion either. 25.When to stop using GnRHa in combination with GH in children with CPP? Answer: GnRHa should be stopped and only GH should be used in girls with BA ≥ 12.5 years old and boys with BA ≥ 13.5 years old. 26.What is the situation that GnRHa is not suitable for children with CPP at first diagnosis? Answer: a. Bone age ≥ 12.5 years for girls and BA ≥ 13.5 years for boys; b. 1 year after menarche for girls or ejaculation for boys; GH alone should be used in the above cases. 27. What are the redness, pain, fever and itching at the injection site of the child, with the area ranging from peanut to egg size? Answer: a. rhGH is produced by E. coli secretory gene expression technology, GH purity is very high, usually no allergic reaction; b. The above cases are mostly caused by allergy to alcohol or iodophor sterilization methods, the solution is to change the non-allergic sterilization methods. 28.Why did the child have a low fever when GH was injected? Answer: a. Foreign literature reports that GH treatment can make a very small number of children susceptible to upper respiratory tract infection and otitis media, and develop a low fever, but the symptoms are generally mild; they will disappear with the prolongation of the drug. 29.Why does the child show symptoms of nail resistance when injecting GH? Answer: a. Foreign literature reports that a very small number of children with hyperthyroidism in GH treatment have symptoms of hyperthyroidism, which is an autoimmune disease, because these children have Job’s thyroiditis. b. The treatment plan for such children should be under the guidance of an endocrinologist. 30. Can children with hepatitis B and C who are short be treated with GH? Answer: a. Hepatitis B and C are the high incidence of hepatocellular carcinoma, and IGF-I has the effect of promoting mitosis and inhibiting apoptosis, so GH therapy is not recommended. b. Hepatitis B and C in active stage must not be treated with GH; c. Hepatitis B and C in stable stage with normal AST and ALT can be treated with GH. The National Pharmaceutical Administration, the US FDA and the European EMEA have clearly indicated that growth hormone is an effective and safe treatment for dwarfism.