1.How to deal with bleeding at the injection site after the patient injects 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 the syringe is pulled out and there is extra- and subcutaneous bleeding at the eye of the needle, 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 need for hot compress in summer), which will disappear in 3-5 consecutive days. BD needle tip is thicker and longer than Novo and pen, so the BD needle injection injection site bleeding slightly more, but are relatively rare. d. After the injection pull out the needle too slow easy to bleed, should be quickly pull out the needle.
2.How to deal with the patient’s bulging bag when injecting 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, there is no need to deal with it, let the skin absorb the drug by itself, it will not affect the efficacy of GH and will not cause harm to the child’s body. b. The correct angle of the needle when injecting GH is 45 degrees and injected into the skin. c. The needle enters the skin, but the speed of injecting GH is too fast and easy to bulge the bag, 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. Take it out of the refrigerator 30 minutes before injection; warm it up with your hands; b. Pain may be caused by the fast injection speed, so you should inject slowly; c. If the pain is sharp because the injection stimulates the peripheral nerves of the skin, you can pull out the needle and change the injection site at this time; d. Relax the child’s spirit before injection, which can avoid the injection pain.
5.After a period of injection, does joint pain or myalgia occur?
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 it when it occurs 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.
8.What about edema 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, and will not cause fat.
12.Why should each injection point be two centimeters apart from the previous injection point 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: the incidence of new tumors such as leukemia will not increase.
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 human 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 taking GH when treating a cold?
Answer:The general medicine for cold and flu does not affect the efficacy of GH.
18.Do I need 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 there is no need 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 evaluation, 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 powder produces antibodies; c. low thyroid function; d. using glucocorticoids; e. epiphyseal plate closure; f. inaccurate measurement; g. having systemic chronic diseases; h. ineffective GH treatment; i . Whether the resident child is adherent to G H.
22. How old can GH treatment be discontinued until bone age?
Answer: When girls are 14 years old and boys are 15-16 years old, the general growth rate is less than 2cm/y, and GH can be discontinued to reduce the financial burden of parents.
23.What is the age of bone that can not use GH?
Answer: At the first visit, when girls BA 14 years old and boys BA 15 years old, the growth rate is less than 2cm/y; at this time, the child’s growth space is very limited, so GH treatment is generally 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: If BA ≥ 12.5 years old for girls and 13.5 years old for boys, GnRHa should be stopped and only GH should be used.
26.The first diagnosis of CPP children should not use GnRHa situation?
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.The child has redness, pain, fever and itching at the injection site, with an area varying in size between peanut and egg?
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. The treatment plan for these children should be under the guidance of an endocrinologist.
30. Can dwarf children with hepatitis B and C 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.