Human growth hormone, a hormone secreted by the anterior pituitary gland, is the most important growth-promoting hormone in the body. The growth of children’s height is mainly achieved through the division and proliferation of cells in the cartilage plate between the long bone stem and the epiphysis, and growth hormone has a significant effect on the division and proliferation of cartilage cells. The efficacy of recombinant human growth hormone in the treatment of pediatric dwarfism has been affirmed for more than 20 years, and its therapeutic indications have been gradually expanded, mainly including the following diseases.
Growth hormone deficiency (GHD): GHD is the main cause of childhood dwarfism, and is the best indication for growth hormone. Treatment: The starting dose is 0.1~0.14 IU/kg/day, and the treatment should be started at an early age. Children with GHD who are in puberty and have short stature can be treated with gonadotropin-releasing hormone analogues to inhibit the acceleration of bone age, prolong the time of epiphyseal closure and increase the duration of growth hormone use, which can achieve better results. The effectiveness of growth hormone treatment is related to the degree of growth hormone deficiency, the age at which treatment is started, the course of treatment, genetic height and individual sensitivity to growth hormone.
Idiopathic dwarfism: Idiopathic dwarfism refers to short stature caused by no known cause, including normal variant dwarfism (including familial dwarfism and delayed puberty) and partial growth hormone insensitivity. Growth hormone treatment: Children with idiopathic dwarfism do not lack growth hormone, so the dose is larger than that of GHD patients, generally 0.15-0.20 IU/kg per day, and the efficacy is observed for 3 months. In puberty, gonadotropin-releasing hormone analogues can be used in combination to delay the acceleration of bone age by sex hormones and prolong the use of growth hormone.
Third, patients with precocious puberty with dwarfism: Patients with precocious puberty often cause adult lifetime height lower than the genetic target height, especially patients with dwarfism. Therefore, some patients with precocious puberty need to be treated with growth hormone at a dose of 0.15 to 0.20 IU/kg per day, which can be used in combination with gonadotropin-releasing hormone analogs or alone.
Turner syndrome: also known as congenital ovarian hypoplasia, is caused by complete or partial deletion or structural aberration of one X chromosome in all or some somatic cells, and some patients have growth hormone deficiency. Growth hormone treatment: The principle of growth hormone treatment for Turner syndrome is timely diagnosis and early treatment, and the younger the patient is, the better the outcome. For those with growth hormone deficiency, the dosage is the same as that for growth hormone deficiency; for those without growth hormone deficiency, a higher dosage is needed: 0.15-0.20IU/kg per day, and estrogen treatment can be added until the age of 12 years.
V. Children less than fetal age: the birth weight or length is less than 2 SD of the weight or length of a normal child of the same fetal age; SGA has spontaneous catch-up growth after birth and can catch up with normal children of the same age at the age of 2. About 10% of SGA are still below 2 SD in height in children and adults. The dose of growth hormone treatment is 0.15-0.20IU/kg per day, and the treatment will be stopped and observed after catching up with the normal height of children of the same age.
Prader-Williy syndrome: Prader-Williy syndrome is a syndrome caused by paternally imprinted SNRPN gene and some other gene deletions, which manifests as short stature, severe obesity, low muscle tone, intellectual development disorder and gonadal dysplasia. Growth hormone treatment method: the dose is 0.15~0.20IU/kg per day, and the efficacy is observed.
Noonan syndrome: Noonan syndrome is an autosomal dominant disorder characterized by short stature, congenital heart defects and special facial features and signs, including wide eye spacing, downward strabismus, triangular face, webbed neck, short neck, low ear position, and chest deformity (thoracic narrowing or sternal inversion). Growth hormone treatment: the dose is 0.15~0.20IU/kg per day, observe the efficacy.
Idiopathic arthritis: Recent studies have shown that children with juvenile arthritis treated with glucocorticoids are effectively treated with growth hormone, which is different from previous reports, so children with dwarfism suffering from idiopathic arthritis can be treated with growth hormone at a dose of 0.15-0.20 IU/kg per day for 3 months, and those who are effective can continue treatment.
Growth hormone treatment should be followed up and observed during the course of treatment, usually once every 3 months. The items include height, weight, insulin-like binding factor-I and insulin-like binding factor-3, blood glucose and liver function every 3 months; thyroid hormone should be tested at the end of the first course of treatment, and if it is normal, there is no need to test it later. If it decreases, follow up according to hypothyroidism treatment; bone age test, once a year during the pre-development period and once every six months during the puberty development period.
Discontinuation time: The drug can be discontinued when the height growth rate is less than 2 cm per year and the bone age is 16 years old for boys and 15 years old for girls during the course of growth hormone treatment after the developmental period.