Hormonal therapy in the treatment of various ailments is gradually becoming the norm. For instance, insulin injections for the management of diabetes caused by insufficient production of insulin have been in the medical practice for a couple of decades. This has paved the way for other hormonal treatments like growth hormone therapy.

What is Growth Hormone Therapy?

Growth hormone, also called somatotropin, is a peptide hormone produced in a pulsatile technique by the pituitary gland upon stimulation by the hypothalamus. The growth hormone stimulates cellular replication and growth and prolongs cellular life, particularly in bone tissue. Growth hormone levels are noted to spike during sleep, supporting the popular belief that children grow during sleep.

What causes Growth Hormone Deficiency?

Growth hormone deficiency may be due to two reasons. One is the insufficient synthesis of growth hormone at the pituitary level, and the other occurs when tissue fails to respond to somatotropin. In both scenarios, growth hormone deficiency will manifest as:

• The patient presents with a short stature
• There will be delayed sexual maturity. This means that secondary growth during puberty tends to happen either in late adulthood or may fail
• Low bone and muscle mass leads to the formation of frail bones
• Reduced energy and a lack of motivation to engage in high-performance activities
• The patient may present with type 2 diabetes because of insulin resistance
• A high waist-to-hip ratio due to the accumulation of fat around the waist
• In children, delayed milestones and tooth development will occur. Also, kids with GH deficiency tend to have stunted or delayed nail and hair growth
• It may also affect a child’s ability to learn and form memory Adults with GH deficiency are more prone to developing anxiety and depression

Classification of Growth Hormone Deficiency

GH deficiency is classified based on the etiology or the age of onset. It is important to note that some children are born with genetic mutations or congenital malformations that cause growth hormone deficiency. In others, GH deficiency develops as they grow due to hormonal changes or damage to the hypothalamus or pituitary gland. Therefore, GH deficiency is classified as:

• Congenital growth hormone deficiency that occurs at birth
• Acquired growth hormone deficiency that develops as the child grows or its onset is observed in adulthood
• Idiopathic growth hormone deficiency where the exact cause of deficiency is not known

Growth Hormone Replacement Therapy

The intravenous administration of exogenous recombinant growth hormone manages growth hormone deficiency. However, before its administration, patients must undergo a series of tests to determine if the candidate is ideal for growth hormone replacement. These tests include a physician’s examination of growth patterns based on height, weight, and Body mass index. Other tests include blood sugar tests to assess the liver and pancreas function and a growth hormone stimulation test.

Indications

Growth hormone replacement therapy is indicated for children and adults with:

• A confirmed growth hormone deficiency diagnosis
• Patients with idiopathic short stature that is not associated with growth hormone insufficiency
• Patients diagnosed with Turner’s Syndrome
• Patients diagnosed with Prader-Willi Syndrome or Noonan Syndrome

Other off-label uses include:

• The use of growth hormone in elderly patients as an anti-ageing regimen
• In the management of multiple sclerosis
• As an adjuvant in the management of short bowel syndrome, ulcerative colitis, and Crohn’s disease to minimize over-reliance on parenteral nutrition
• Fibromyalgia
• Heart failure
• Lipid disorders

How does it work

Administration of growth hormone is done daily by a trained nurse for optimal results. It is important to note that every dose must be given for maximum growth. If there is a missed dose, one should continue with the same regimen on the following days without compensating for the missed dose. The effect should be apparent for children within the first year of therapy, after which treatment should be discontinued. Luckily with more research, growth hormone shots have been made more long-acting. The newer long-acting growth hormone is injected once a week, reducing the number of shots to four per month.

Is GH Replacement Therapy Safe

Growth hormone replacement therapy is tolerable for both adults and children. Its effect is more apparent in children because of the open bone epiphyses observed in kids. Exogenous growth hormone is generally safe; however, if you observe any of these symptoms, you must notify your doctor for a review. Some of the side effects that one should be on the lookout for are:

• Headache
• Swollen feet or hands
• Spinal curvature
• Hip pain due to hip dislocation

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