[Treatment
1.Therapeutic measures for children with short stature depend on their etiology: children with psychosomatic and renal tubular acidosis will see an increase in their height growth rate after the relevant factors are eliminated, and the protection of daily nutrition and sleep is closely related to normal growth and development.
2.Growth hormone: With the accumulation of experience in the clinical application of recombinant human growth hormone (rhGH), the number of diseases approved for treatment with rhGH is gradually increasing, and since the FDA approved rhGH for the treatment of growth hormone deficiency in 1985, the diseases approved one after another include chronic renal failure (1993), congenital ovarian hypoplasia (1996-1997), Prader-Willi syndrome (1996-1997), and the growth hormone deficiency in children with the disease. Prader-Willi syndrome (2000), small for gestational age (2001), and idiopathic short stature (2003).
Since most children younger than gestational age show catch-up growth in the first 2-3 years of life and can reach a growth curve proportional to their target height, they should be regularly followed up and observed. Generally, GH treatment should be considered at 3 weeks of age if their growth is still lagging. 2003 FDA approved GH for idiopathic short stature, namely.
(i) those with non-GH deficiency of unknown origin;
②Height is below the normal reference value of 2.25 SD or more for children of the same sex and age;
(iii) their lifetime height in adulthood is expected to be -2SDS or less.
(1) Dosage form. There are two types of rhGH powder and water dose available in China.
(2)Dose. The dose of growth hormone has a wide range and should be individually adjusted according to the need and the observed efficacy. At present, the commonly used dose in China is 0.1-0.15IU/kg・d, 0.23-0.35mg/kg per week; for children with pubertal development, children with Turner, children younger than fetal age, children with idiopathic short stature and some children with partial growth hormone deficiency, the applied dose is 0.15-0.20IU/(K.d), 0.35-0.46(J.K) per week (Note: WHO labeled growth hormone 1J=30). WHO labeled growth hormone 1J=30U)
(3) Usage: 1 subcutaneous injection every night before bedtime, the usual injection site is the outer and anterior flank of the middle 1/2 of the thigh, and the injection site should be changed each time to avoid the degeneration of subcutaneous tissue due to repetition within a short period of time.
(4) Course of treatment: The course of growth hormone treatment for short stature depends on the need, usually should not be shorter than 1-2 years, too short when the child’s benefit to its lifelong high role is not great.
(5) Side effects: The common side effects are.
① Hypothyroidism: Occurs every 1-3 months after the start of injection and can be corrected by giving L-thyroxine tablets as needed;
② Altered glucose metabolism: Long-term use of large amounts of growth hormone may cause insulin resistance to occur in children. Fasting blood glucose and insulin levels may rise, but rarely exceed the normal high limit, and may recover after several months of growth hormone discontinuation;
(iii) Idiopathic benign intracranial pressure elevation: Growth hormone can cause nadir and water retention, and individual patients may experience idiopathic intracranial pressure elevation, peripheral edema and blood pressure elevation, mostly in children with chronic renal failure, Turner’s syndrome and GH deficiency-induced growth disorders, and GH therapy can be suspended and small doses (e.g., hydrochlorothiazide) can be added to reduce intracranial pressure;
④Antibody production: Due to the continuous improvement of preparation purity, the rate of antibody production has been reduced;
(5) Slippage and necrosis of femoral head: Because of the accelerated growth and muscle strength of the bones after treatment, it is easy to cause slippage, aseptic necrosis and claudication of the femoral head when there is more movement, and pain in the knee and hip joints, and external rotation pathology.
(7) Possibility of tumor induction: International organizations have conducted relevant research studies, based on a large amount of epidemiological data from academic institutions such as the National Cooperative Growth Group and the Center for Drug Therapy Research, including a comprehensive analysis of population information such as age, gender and race of tumor patients, the results show that GH treatment does not increase the risk of leukemia occurrence and tumor recurrence in children without the presence of potential tumor risk factors, but for However, for those who have had tumor, have family genetic tendency of tumor occurrence, malformation syndrome, caution is needed when long-term supraphysiological dose of GH is applied, and serum IGF-1 level should be closely monitored during treatment, and those who exceed the normal reference value +2SD should be temporarily discontinued.
3. Other drugs.
①The supplementation of calcium and trace elements should be paid attention to during the course of treatment for the bone growth required;
②Anabolic hormone: often used with growth hormone to treat Turner syndrome, most domestic use stanozolol (Conilon), the common dose of 0.025-0.05J/(K.d) need to pay attention to the growth of bone age;
③ IGF-1 gonadal axis inhibition (GnRHa), aromatase inhibitors (Letrozole, Letrozole) have also been used to treat short stature, but there is no sufficient data analysis in China, so it is not recommended for routine application.
4. Exercise: Exercise will stimulate growth hormone secretion for 20 minutes each time, 2-3 times a day.