Height measurement: It is necessary to measure the height of patients with either short stature or precocious puberty every month after treatment, and since the change in height within a month is small, it is necessary to measure it as accurately as possible. Accurate height measurement needs to pay attention to “four similarities”: ① the same time, because after standing or sitting up, the vertebral space of the human spine will be compressed, so the height will be different in the morning and the evening, and the measurement will be comparable only at the same time; ② the same measuring tape; ③ the same measurer, different people, the tightness of the tape card on the head will be different; ④ the child the same method of standing (requiring shoes off, heels, hips, shoulders and head all against the wall, chest up, stomach in, waist as straight as possible, eyes level, head not too tilted, otherwise the highest point of the head can not be measured). If you measure at home, you can put a piece of paper on the wall, and draw a line on the paper after each measurement. It is not necessary to measure the specific height of each measurement, but only to distinguish the difference with the previous month. When measuring at home must pay attention to the ruler and the floor level, you need to use a right angle triangle ruler, or use a hard book, one side against the wall, the other side and the floor level. Parents often respond, “My child grew by 2cm last month, but he hasn’t grown at all this month?” The main reason is that it is still related to the measurement error. After a longer treatment time, the growth rate can be averaged over several months (Note: usually do not measure height too often, in general, height and weight can be measured once a month (and it is recommended to keep good records), otherwise it is easy to cause psychological pressure to the child, too much psychological pressure is not conducive to growth). Since the drug dose is generally calculated according to body weight, if the weight change exceeds 10%, it may be necessary to adjust the drug dose (during the six-month review period, the body weight should be controlled appropriately, and the change should not exceed 10% as much as possible).
Growth hormone treatment review time and items: For those who apply growth hormone treatment, after 3 months of treatment, it is necessary to review thyroxine (mainly FT3, FT4 and TSH) and fasting glucose (Note: Since the normal standards of thyroid function on the laboratory list are adult standards, for adult children, if TSH is within the normal range, FT3 and/or FT4 are normally high or slightly higher than the normal adult standards), it is normal and does not require any review. (For adult children, if TSH is within the normal range and FT3 and/or FT4 are normally high or slightly above normal adult standards, they are normal and do not require any treatment). Since most of the treated patients are dwarf patients with low thyroxine requirement due to too slow growth rate in the past and increased thyroxine requirement after significant acceleration of growth, a few may cause a relative deficiency of thyroxine. Insufficient thyroxine requires oral levothyroxine tablets for a short period of time, otherwise the efficacy of growth hormone will be affected (there are also a few cases of slightly high thyroxine due to excessive thyroxine regulation, at this time, as long as TSH is not too low, there is generally no need to deal with it, and continued use of growth hormone will often drop to normal automatically). In addition to thyroxine and blood glucose, bone age and insulin-like growth factor-1 (IGF-1) and insulin-like growth factor binding protein-3 (IGFBP3) should be checked when the IGF test is repeated in about six months (since the IGF test is to understand the situation after the medication, it is necessary to continue the medication as much as possible when the test is repeated, otherwise the reliability of the results will be affected. The IGF test results may vary greatly from hospital to hospital, and there are some hospitals where the reliability of the reagents may not be high.
Growth hormone dose adjustment: growth hormone generally does not need to be adjusted within a short period of time, and weight change of not more than 10% generally does not need to be adjusted, even if adjusted, not only according to growth rate or weight. It is also necessary to consider different etiologies, the results of the growth hormone provocation test before the initial dosing, youth development, bone age size, and especially the results of IGF-1 and IGFBP-3 review. Regular review is also necessary! Although the effect of treatment is important, the safety of medication is more important! The dose of growth hormone has a wide range. For those with small bone age and sufficient treatment time, we generally start with a smaller dose within the normal range, if the small dose is more effective, the cost is relatively low and side effects are less likely to occur, if the effect is not satisfactory, then consider adjusting the dose. For children with older bones and limited treatment time, generally start with a medium or large dose of the normal range, because of the limited time and slow observation may affect the final treatment effect.
Growth hormone discontinuation indicator: For those who start treatment at a younger age, the treatment can be temporarily stopped for a period of time when the height reaches or slightly exceeds the height of the same age (usually takes 2~3 years or longer), and then used again when the height is significantly lower than that of the same age. For people with older bone age, due to the limited treatment time, the indicator for stopping the drug is to stop when the monthly growth rate is less than 4mm for three consecutive months (although growth hormone can still play a role of 1-2mm/month when 3mm per month, but the available time is already very little, the magnitude of too small increase is not substantial). However, for those whose height has approached normal adult height during the period of use, discontinuation of the drug may also be considered, but a detailed assessment of whether the therapeutic goals have been achieved is needed before discontinuation. If the drug is discontinued 3 months or more after the last review, it is best to check liver and kidney function, blood sugar and thyroid function locally, and if these tests are normal, the drug can be discontinued directly (no need to slowly reduce the dosage and then stop).
GnRHa treatment review program and dose adjustment: Because of precocious puberty patients GnRHa (gonadotropin-releasing hormone analogues, commonly used drugs such as Treprostin, Dabigat, or leuprolide, such as: suppression of Nadir, Bayi, Boenocon) treatment dose is a difficult point, need to be individualized, that is, each person, the dosage may be different at different times. Especially the first six months to one year of treatment need to be reviewed from time to time. The height growth, sexual development control, ultrasound (girls, boys only need to measure testicular size), sex hormone levels [generally sex hormone six, which need to include at least LH, FSH and E2 (female) or T (male)] should be reviewed 2 months and 6 months after treatment, and GnRH stimulation test etc. The bone age should be reviewed every 6 months in order to adjust the dosage at the right time. Too high a dose will result in too slow growth and will not help much to improve adult height, too low a dose will be difficult to control during puberty and will not achieve the therapeutic goal. According to the guidelines of precocious puberty, it is better to evaluate the bone age in detail because it is difficult to identify the growth of bone age without detailed evaluation because of the short time interval, which is not conducive to dose adjustment. The dose adjustment of GnRHa is mainly in the first six months, and after six months, if there are no special changes, it is usually once every six months, and the review items are the same as the review at six months.
At present, in GnRHa treatment for more than two months when the review, often used to check the injection of GnRHa about 1 hour after the method of sex hormones, so equivalent to a simple stimulation test (the first dose has been enhanced, injection of the third injection is often less than 1.5 months, generally do not check the injection after one hour value), unless the treatment is not smooth, when the review, generally rarely do the standardized GnRH stimulation test.
GnRHa discontinuation indicators: application is generally not less than two years, in the bone age and age, and reached or close to the age of normal sexual development, the predicted height is slightly higher than the target height when (generally to 2 ~ 3cm higher) can be considered to discontinue the drug. For girls, discontinuation of the drug is generally considered when the bone age is not too great, the age is greater than 10 years old, and the height is around 150 CM. Because after stopping the drug, there is still 2~3 months of slower bone growth time, but some people may have a faster bone growth period in the following 2~4 months, and the later rapid bone growth may lower the predicted height. Or stop the drug when the bone age of girls is more than 13.5 years old, boys bone age is more than 14.5 years old, even if the combination of growth hormone, can not play a role in improving lifelong height, but growth hormone can be considered to continue to use. When the GnRHa discontinuation index is reached, the drug can be directly discontinued, and generally no special examination is required.
For pseudo or partial precocious puberty oral Chinese medicine, generally is every 3 months to review ultrasound, sex hormones (generally check sex hormone six, at least need to include LH, FSH and E2), if necessary to review GnRH stimulation test. Bone age should be checked every 6 months.
Precautions after injection of recombinant human growth hormone: Since growth hormone is a hormone normally secreted by the human body every day, rhGH is exactly the same as the growth hormone secreted by the human body itself, there is no need to associate any abnormalities that occur with rhGH during the medication period. Growth hormone also will not promote sexual development or promote bone age growth as some people think (although growth hormone deficient people may originally have small bone age, after applying growth hormone to make it normal, there is the possibility of transition to normal bone age), otherwise it will not be used to improve lifetime height. If you are more ill, consider stopping the use for a few days as your own growth will be affected. If you have special circumstances, it is not much of a problem to stop using it for a few days. Since normal people also secrete growth hormone every day, the application of general medications or preventive vaccinations, etc., during the use of the drug is not affected.
GnRHa is an amino acid replacement of normal human gonadotropin-releasing hormone (GnRH, a 10-peptide), making it bind more strongly to the gonadotropin-releasing hormone receptor on the pituitary gland without acting as a gonadotropin-releasing hormone to inhibit pubertal growth. Overall safety is good. Some side effects on the instruction are mainly for adults, because the adult sex hormone level is high, and the sudden suppression will cause a series of side effects such as osteoporosis and other sex hormone decline. During the medication period, the application of general drugs or vaccination is not affected in case of illness, and the same applies to oral Chinese medicine in case of pseudo-precocious puberty.
As the number of letrozole users increases, those who use letrozole need to pay more attention to regular safety monitoring, after all, this kind of drug has not been officially approved for the treatment of precocious puberty in China. Because the use of letrozole may cause osteoporosis due to a significant decrease in estrogen levels, it is necessary to check: bone mineral density, 25 hydroxyvitamin D and bone alkaline phosphatase before using letrozole, and the bone age degree is normal before use. During the course of medication, attention should be paid to diet control to prevent excessive weight gain, and the above three tests need to be reviewed regularly every 3 months, and any problems need to be dealt with promptly or letrozole use should be suspended.
For those who use Stanozolol combined with growth factors, liver and kidney function should be checked every three months, and diet should be controlled to prevent excessive weight gain.
Special Note: If you have been using GnRHa for about 2 months, if you want to get medication guidance through this website after reviewing ultrasound and sex hormones locally, you must write down detailed medical history, bone age, predicted height and other examination results before medication, medication mode, name and dose, whether the first dose is enhanced, whether combined growth hormone treatment, when to start growth hormone and growth hormone dose and before and after treatment Changes in height and weight, control of sexual development (e.g., changes in breast and testicular size, secretion in girls, menstruation in those who already have menarche, etc.), etc., as well as post-medication examinations for comparison. Since I am usually at home when answering consultations, I do not have the consultation information at hand (online dose adjustment is limited to about 2 months of GnRHa injection, and it is difficult to make appropriate adjustments through the Internet).