What types of dwarfism can be treated with growth hormone?
The most common and primary indication for growth hormone is for the treatment of patients with growth hormone deficiency, which is the type of disorder that is most effectively treated with the drug. The next most common indications are non-growth hormone deficiencies, including idiopathic dwarfism and Turner’s syndrome due to growth hormone deficiency or lack thereof.
What kind of therapeutic effects does growth hormone have?
Growth hormone has two main effects. The first is to promote growth and, in childhood, mainly to help it grow taller. Secondly, growth hormone can affect glucose and lipid metabolism. For example, in patients with severe growth hormone deficiency, blood lipids are elevated and a lot of fat accumulates in the abdomen and chest, which affects their appearance. After the drug is administered, the blood lipids will return to normal, the fat accumulation in the abdomen will gradually disappear, and the person will become slimmer and more muscular.
Therefore, patients with growth hormone deficiency are recommended to use growth hormone in small doses under the guidance of a doctor, even if they have no need to grow taller as adults. This is beneficial for improving metabolism and lifelong health.
For children with non-growth hormone deficiency, the purpose of medication is to promote their growth. Generally, the medication is discontinued when the height reaches within the normal range of height. For those who are in the normal short height range but require height increase, treatment is not medically recommended.
What are the side effects or adverse reactions that can occur with the use of growth hormone?
In general, if used in strict accordance with the drug instructions and indications, growth hormone is a relatively safe drug with few side effects or adverse reactions.
If side effects or adverse reactions occur after the drug is administered, they are mainly related to the dose of the drug. In a normal human body, growth hormone is naturally secreted by the body and is sufficient for physical growth. When treating growth hormone deficiency, we use small dose replacement therapy, i.e., how much is lacking to make up for the deficiency, replacing the normal physiological needs of the body with drugs. This dose is basically safe. If used for the treatment of non-growth hormone deficiency, such as idiopathic dwarfism, Turner syndrome, etc., the dose used is relatively large, or the duration of medication is longer, the side effects will become apparent.
1. Elevated blood sugar: Some diseases that cause excessive growth hormone in the body, such as gigantism and acromegaly, have abnormal glucose metabolism, resulting in elevated blood sugar. When using growth hormone replacement therapy, if the drug dose is high, it may also cause abnormal glucose metabolism, and in severe cases, type 2 diabetes may occur. However, there are individual differences and this may be related to family history.
2. Local skin reactions: such as local itching, redness and swelling, mostly seen in some early drugs. However, nowadays, as the purity of growth hormone preparations is getting higher and higher, the quality of domestic preparations is also getting better. These local reactions are almost gone. Some children may experience local pain after injection, which is mainly related to psychological factors and can be tolerated.
3. Pseudotumor cerebri: Children will have headache and increased cranial pressure after injection. After stopping the drug, these symptoms will disappear. In this case, parents should be reminded to take their children for regular review and to go to the hospital when discomfort occurs.
4, joint slippage: this is a very rare case, mainly related to the accelerated growth of the child after the use of the drug. The problems that parents are more concerned about and pay more attention to also include the fact that growth hormone will promote cell proliferation and division, which may induce tumors or recurrence. However, from the use of our hospital and the large amount of international statistics, the incidence of tumors does not increase significantly due to the use of growth hormone.
In addition, some children may experience pain in their limbs due to accelerated growth, especially occurring in the afternoon. We call this growing pains and it is a normal condition. We have also encountered some children in our clinic who have found some scoliosis in their spine after using the drug. Our analysis revealed that these children had less obvious congenital deformities and scoliosis in their spine before the growth hormone injection. However, the doctors did not examine them carefully before treatment. As the height increased, the problem came to the fore and the parents noticed it and assumed it was a side effect of the drug. In fact, the two are not related.
Are there any individual differences in the possible adverse effects and side effects of growth hormone?
Yes. All drug reactions are related first to the drug itself, and then to individual differences. We require doctors to keep good records before using growth hormone, to carefully check whether the child has scoliosis, etc., and to do basic routine biochemical tests. And considering that groups and individuals are different and everyone has the risk of developing tumors, it is important to give the child the appropriate examination and understand his or her family history of the disease, etc.
What tests should be done for children before using growth hormone?
Tests include preventive tests and etiology tests. Preventive tests include basic blood and urine routine, liver and kidney function, blood sugar, the presence of multiple pituitary hormone deficiencies, and tumor marker tests (which can alert to the development of tumors). Some children develop hematuria or proteinuria when growth hormone is used. Without prior basic testing, the doctor cannot tell whether the patient has a pre-existing underlying condition or an adverse reaction to the medication.
Etiology testing includes an MRI of the pituitary gland, if necessary. Some growth hormone deficiencies arise etiologically from pituitary hypoplasia or, in rare cases, pituitary growth hormone deficiency caused by tumor compression. This can be detected by MRI.
How often should I be reviewed for growth hormone injections and what are the items included?
Most of the diseases that are treated with growth hormone are not temporary diseases. In other words, it is not like a cold or flu that has stages and heals in a few days or weeks, but often requires long-term treatment. This also requires regular review and follow-up.
Generally, we require a routine checkup in the first month after using growth hormone, and then a review every three months after that. The first purpose of the checkup is to see the effectiveness of the treatment and to monitor the child’s physical development and height changes after the drug is administered. The second is to monitor the results of various laboratory tests to see if they show any adverse reactions or side effects.
Do I need an MRI if my child has pseudo-headaches or other brain symptoms, or as part of a routine review?
Usually not. This diagnosis is mostly a one-time procedure to look at the development of the hypophysis to identify congenital intracranial malformations and pituitary hypoplasia, or to rule out pituitary abnormalities caused by secondary tumor compression or intracranial hemorrhage injury. And the child has already had MRI before the medication, there is no need to repeat it after the diagnosis is confirmed.
Moreover, pseudo headache or pseudo brain tumor is a known side effect of the medication. We will stop the medication for a week first, and if the symptoms recover completely, it means it is a medication problem. Most children who stop the medication for a period of time and then use it again are able to continue treatment without having headache symptoms a second time.
If you have an adverse reaction to growth hormone, stop the medication first and observe.
Is it true that when a child has an adverse reaction to medication, the first thing to do is to suggest that he or she stop the medication for a period of time, and if the symptoms disappear, it means that it is related to the medication?
Parents should first read the drug instructions carefully before giving the drug to their children. If an adverse reaction occurs after using the medication, you should also check the drug instructions, which are all prompted.
For some minor and common adverse reactions, the drug can be stopped for observation. For example, if blood glucose rises, you can stop the drug to see how blood glucose recovers. Before using the medication, special emphasis should be placed on finding out if there is any family history of diabetes and oncological disease. We must tell parents that if there are these conditions in the family, they must be cautious in the process of medication use and insist on regular rechecking. It is not possible to use growth hormone for six months or a year without a review, which is irresponsible to the child.
How long is it appropriate to stop taking the medication?
This varies from person to person and from symptom to symptom. It is recommended that all discontinuation and resumption of medication be monitored by a physician and that parents do not take matters into their own hands.
Is the fever after growth hormone injections related to the medication? How can it be treated?
In the course of clinical use, we have not encountered any cases of fever caused by growth hormone injections. When this phenomenon occurs, parents should first determine if this is a concomitant disease. Children may not know when they have a cold, develop laryngitis, tonsillitis or diarrhea, etc. And it is these primary illnesses that may cause a fever. Therefore, parents should first take their children to the doctor to confirm the diagnosis of the primary disease and target treatment. During the treatment of the primary disease, growth hormone can be used normally.
Should I stop using growth hormone if I have localized redness and rash after injecting it?
When localized redness and rash occur after using growth hormone, the first step is to identify the site of the skin reaction. Skin reactions caused by allergy to the drug or insufficient purity of the drug tend to occur locally on the skin where the drug was injected and not on other areas. If it is a patchy rash on other parts of the body or all over the body, you should consider whether it is due to other medications or food allergies and should promptly go to a dermatologist for an examination. If parents have great concerns about growth hormone, they can also stop the drug under the guidance of a doctor and observe it for a period of time.
What can I do if I have edema on my face and eyes after growth hormone injections?
The use of growth hormone will help the child return to as normal a growth level as possible, with changes in height and weight, but no puffy eyelids or swollen stomach will occur. At least in years of clinical use, I have not heard such feedback. This may be related to some lifestyle habits or other diseases of the child, which can be further examined at the hospital.
How to identify and manage knee pain after injection?
Overall, the chance of developing growing pains in the treatment of growth hormone deficiency is very low. Some children will have knee discomfort, but not pain, during the beginning of the treatment phase. At this point, we have to assess how fast the child is growing. If the child grows relatively fast, i.e., he or she can catch up with the growth rate during normal development, up to 8-10 cm a year, then feeling some soreness in the legs at night and in the afternoon can be considered growing pains. This may be the result of accelerated growth and need not be too much of a concern.
At the same time, some children will tell me that their joints are uncomfortable when they are reviewed. I will then follow up with him to ask him specifically where and how it hurts. However, in most cases, I do not find a clear, specific area of pain. At this point, no further testing is needed.
If the child can clearly say where the pain is and if the pain lasts for a long time, the presence of orthopedic aspects should be considered and further examination should be done in the relevant department.
Can growth hormone injections cause the hands, feet or joints to get bigger?
No. Generally there is a reference template for what a child can grow into, and that is the parents. Height growth or growth hormone action is under the control of the body’s genes. Growth hormone injections are not designated to stimulate the growth of fingers and toes, but work throughout the body. This parent’s expression may be overly concerned.
It is recommended that parents make a daily growth record for their child before and after the use of growth hormone. Nowadays, cell phones are multi-functional and convenient. Parents can measure and photograph the size of their child’s hands and feet to use as a basis for comparison in treatment.
Does elevated blood sugar mean an increased chance of diabetes? Can it be reversed?
In the treatment of growth hormone deficiency, the dose of medication used is very small and basically equal to the normal physiological needs of the body and does not usually cause an increase in blood sugar.
In the case of non-growth hormone deficiencies, such as idiopathic dwarfism and Turner syndrome, the dose of growth hormone is higher, 50% or even double the normal physiological needs. In this case, there is a greater chance of elevated blood glucose. However, overall, this is not a common side effect. And progression from elevated blood glucose to type 2 diabetes is much rarer. Usually, the doctor will stop the drug promptly when the blood sugar rises after the injection. When the blood glucose recovers, the cause is investigated, and any family history of diabetes and other high-risk factors are asked. Finally, a comprehensive judgment is made as to whether to restart the injection.
I have been using growth hormone for two years and found to have low thyroid function, is this long-term? How can I treat it?
Medicated growth hormone is only a replacement to supplement the deficiency of growth hormone in the body, it does not destroy the function of the thyroid gland and cause hypofunction. These are two different things.
For children with problems, the first step is to find out if their thyroid function was checked before the growth hormone injection and if there are any problems. If the previous tests were normal, it is time to look for the cause.
Even children without growth hormone deficiency may develop hypothyroidism (low thyroid) at a certain age. Common causes include congenital hypothyroidism and Hashimoto’s thyroiditis. The cause can be found by checking free T4, free T3, TSH, and checking autoantibodies such as TBO antibodies, GR antibodies, TG antibodies, etc.
If it is clear that it is hypothyroidism, it is important to determine whether it is primary or secondary. Primary hypothyroidism is caused by the thyroid gland itself, while secondary hypothyroidism is caused by the hypothalamus pituitary gland. But in general, it is not related to growth hormone injections.
Growth hormone deficiency is either simple or may be associated with other pituitary hormone deficiencies, which must be clinically differentiated.
Under what circumstances will growth hormone injections produce antibodies? How to deal with it?
Don’t worry about this problem, antibodies to growth hormone were developed a long time ago.
The drug growth hormone before the second generation is structurally different from the growth hormone secreted by the normal human body. The normal human growth hormone has 191 amino acids, while the growth hormone before the second generation has 192 amino acids, which is one more amino acid. For this early product, it is easy to produce antibodies when injected into the body. Therefore, initially, patients were monitored for antibodies before and after treatment with growth hormone.
However, with innovations in production technology, the growth hormone used today is structurally identical to the growth hormone secreted by the body itself, and the vast majority of people will not develop antibodies after using it. Even if a few people do develop antibodies, the levels of these antibodies are so low that they do not affect the efficacy of the growth hormone. Therefore, the antibody problem has been basically solved scientifically, and antibodies to growth hormone are no longer measured during the use of growth hormone worldwide. At the same time, the effectiveness of both domestic and imported drugs is very good.
Does growth hormone inhibit or replace the hormones naturally secreted by the body, creating dependence? Will it grow naturally after discontinuing use?
For children with growth hormone deficiency, growth hormone treatment is to make up for the lack of secretion in the body, in line with the growth pattern of children. The half-life of the drug is very short, so there is no need to consider the problem of suppressing one’s own growth hormone.
For non-growth hormone deficient children, long-term and high dose use of the drug may inhibit pituitary function and affect the child’s own growth hormone secretion. This is not a dependency problem, and there are not a large number of clinical cases that can prove it. However, for such children, we recommend that they use growth hormone 6 days a week and then stop for 1 day.
In addition, I do not recommend that people who are short grow to a normal height range and want to be “taller” to continue using medication. Especially in non-growth hormone deficient patients, you should stop taking the medication when you reach the normal height range.
Will I get fat if I use growth hormone?
There are hundreds of hormones in the human body. Different hormones have different effects. For example, the most common clinical glucocorticoid is secreted by the adrenal cortex, which has the function of regulating the biosynthesis and metabolism of sugar, fat and protein, as well as anti-inflammatory and anti-toxic effects. The familiar estrogen is also a hormone, which is an important hormone for maintaining female physical beauty. Androgens, on the other hand, promote masculine physical characteristics, beard growth, muscle growth and body hair growth.
Growth hormone, as its name implies, promotes growth, has an effect on fat and sugar anabolism, and promotes fat dissolution and muscle production. It is listed as a banned substance in international sports competitions. Therefore, when children gain weight after using growth hormone, they may not necessarily gain weight, but may have more developed muscles.
Will I get precocious puberty with growth hormone?
Growth and development are two different concepts. Growth refers to the growth of organs, with smaller individuals growing larger, taller, and gaining weight. Development is a different concept, which refers to the perfection and maturation of the function of an individual or organ. Growth hormone is a growth promoter, not a gonadotroph.
Normal physiological doses of growth hormone injections do not cause early development. Whether high-dose, long-term injections of growth hormone will have an early effect on development is not easy to say because there is insufficient evidence so far. However, a large number of clinical cases show that most early development is not caused by growth hormone.
At the same time, parents will notice problems with their child’s height at different points in time. For example, some are noticed when they start nursery school; some are noticed when they start school; and some wait until puberty to develop. In particular, it is not uncommon for children aged seven or eight to enter prepubertal development or to enter puberty after using growth hormone for a period of time, coinciding with their pubertal development. Therefore, before diagnosing growth hormone deficiency or using growth hormone for short stature, doctors should carefully record height and development for comparison before and after treatment.
Can the use of growth hormone induce tumors?
There have been cases in Shanghai where tumors were found after 3 months of growth hormone use. However, we know that a tumor does not change from a cell to a mass of cells or become a lump within 3 months. A tumor is an effect that accumulates over a long period of time. This case is most likely because the doctor did not check thoroughly before starting the treatment, especially neglecting to screen for tumors.
A survey of hundreds of thousands of patients treated with growth hormone worldwide found that the incidence of tumors was no higher in those using growth hormone than in normal people. However, on an individual basis, if you have a family history of tumors, you should tell your doctor, who should also do some appropriate tumor marker tests and review them regularly throughout the course of treatment.
Does it affect brain development?
Growth hormone has no effect on mental development and parents should not worry about it.
Will the use of growth hormone lead to early bone closure?
Bone closure is a natural growth process. During growth hormone treatment, the epiphysis continues to grow and mature, and the growth potential is depleted. However, growth hormone differs from sex hormones in that the latter significantly promotes epiphyseal closure, while the former has a less pronounced effect in this regard.
What needs to be emphasized to parents and patients regarding the use of growth hormone?
It is important to remind parents that if they think their child is not reaching normal height or have doubts about his or her development, they should go to a regular hospital with a pediatric endocrinology specialty for treatment. These are mostly tertiary hospitals. Generally, secondary and primary hospitals do not establish pediatric endocrine specialist clinics, but only pediatric health care departments. In addition, you should never go to so-called “developmental centers” or “dwarf centers” for consultation according to the propaganda in newspapers and radio. These institutions may not be hospitals, doctors, or drugs.