Question 1: Fever, is it related to medication? How to deal with it?
Professor: I have not encountered any cases of fever caused by growth hormone injection in my clinical use. When this phenomenon occurs, parents must 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.
Question 2: After growth hormone injection, localized skin redness and rash appear, should I stop the drug?
Professor: When localized redness and rash appear after using growth hormone, the first step is to identify where the skin reaction occurs. Skin reactions caused by allergy to the drug or insufficient purity of the drug mostly appear on the local skin where the drug was injected, but not on other parts of the body. 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 serious concerns about growth hormone, they can also stop the medication under the guidance of a doctor and observe it for a period of time.
It should be noted that in the last five or six years, I have hardly come across any children with a local rash after injection, whether with domestic or imported growth hormone.
Question 3: How can I deal with edema in the face and eyes after growth hormone injection?
Professor: The use of growth hormone will help the child return to normal growth levels as much as possible, with changes in height and weight, but no puffy eyelids or swollen stomach will occur. At least I have not heard such feedback in my years of clinical use. I speculate that this may be related to some of the child’s lifestyle habits or other diseases that can be further examined at the hospital.
Question 4: How to identify and deal with knee pain after injection?
Professor: In general, the chance of developing growing pains in the treatment of growth hormone deficiency is very low. Some children will have knee discomfort at the beginning of the treatment phase, but it is not pain. 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, you should consider the presence of orthopedic conditions and go to the relevant department for further examination.
Question 5: Can growth hormone injections cause the hands, feet or joints to become larger?
Professor: 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 achieved 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.
Question 6: Does elevated blood sugar mean an increased chance of diabetes? Can it be reversed?
Professor: 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, which usually does not cause an increase in blood sugar.
In the case of non-growth hormone deficiency, such as idiopathic dwarfism and Turner syndrome, the dose of growth hormone used 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 will be made whether to restart the injections.
Question 7: After using growth hormone for two years, hypothyroidism was found, is this long-term? How can I treat it?
Professor: The drug growth hormone only replaces and supplements 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 whether their thyroid function was checked before the growth hormone injection and whether 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, and TG antibodies.
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, either simple or may be associated with other pituitary hormone deficiencies, must be clinically differentiated.
Question 8: Under what circumstances will growth hormone injections produce antibodies? How to deal with it?
Professor: Don’t worry about this problem, antibodies to growth hormone have been produced for a long time.
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, 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. Meanwhile, the effectiveness of both domestic and imported drugs is very good.