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Pediatric Growth Hormone Deficiency
Pediatric growth hormone deficiency (PGHD) occurs when the production of growth hormone is disrupted during infancy or childhood.

Growth hormone (often designated as hGH or GH) is secreted by the pituitary gland and plays a critical role in stimulating body growth and development. It is involved in the production of muscle protein and in the breakdown of fats. Decreased levels of growth hormone may result in abnormalities of many body processes, including growth and development, production of muscle protein, and breakdown of fats.

Although PGHD is uncommon, it may occur at any time during infancy or childhood, and there are many possible causes. Some involve damage to the pituitary gland or the hypothalamus, a part of the brain that controls the pituitary. A major sign of PGHD is a marked slowing of growth, usually to less than 2 inches (5 cm) a year.

Pediatric growth hormone deficiency is diagnosed through special blood tests that detect growth hormone in the blood. It is treated by growth hormone therapy, which involves giving injections of growth hormone, such as Primatropin, until the child reaches his or her adult genetic potential height or until the growing ends of the bones fuse.

Looking For Signs of Growth Failure
Many parents are concerned about their children's growth and want to learn more about growth and growth problems. They want to know when to consult a healthcare provider and when not to worry. We've developed a list of questions to help you recognize signs that your child's growth may be falling below normal for his or her age. We've also included tools, such as a pediatric growth chart and growth percentile calculator, that can help you determine potential problems.

How to Recognize Growth Problems
Although most children who are very short or very tall are healthy and normal, some children have diseases or conditions that affect their growth. A child's growth rate is a more important clue to the presence of a growth problem than is his or her size. For this reason, regular, accurate measurements plotted on a pediatric growth chart are very important: A change in the child's growth rate may provide the first hint of an underlying problem. Specifically, a slowing of growth, especially to less than 2 inches (5 cm) per year could be a sign of pediatric growth hormone deficiency or chronic illness.

If you have concerns, discuss them with your child's healthcare provider. Our Doctor Discussion Guide can help. Also, the following questions can serve as guidelines for parents who are worried about their children's growth. While not necessarily indicating a problem, a "Yes" answer to any of these questions* signals a need to discuss the question with your child's healthcare provider.

  • Is my child the shortest or tallest in the class?
  • Is my child still wearing last year's clothes or outgrowing clothes much faster than usual?
  • Is my child unable to keep up with other children of the same age in play?
  • Is my child growing less than 2 inches or more than 3 inches a year?
  • Is my child complaining about his or her size?
  • Is my child showing signs of early sexual development (before age 7 in girls and before age 9 in boys)?
  • Has my 13-year-old girl or 15-year-old boy failed to show any signs of sexual development?

*This list is based in part on Human Growth Foundation (HGF) guidelines.

For more information on these guidelines contact:
Human Growth Foundation
997 Glen Cove Avenue
Glen Head, New York 11545
or call toll-free: (800) 451-6434

One of the most important things parents can do to protect a child's health and growth is to have their child examined regularly by a pediatrician or another qualified healthcare provider. The examination should include accurate measurements (without shoes) plotted on a pediatric growth chart.

Researchers have found that girls are less likely than boys to be referred for evaluation of growth problems, perhaps because short stature is less of a social concern for girls. Poor growth can be a symptom of a serious medical condition, so any child whose height is below the 5th percentile line on the pediatric growth chart or who moves away from a previously normal growth curve should be checked by a healthcare provider.

How do heathcare provides evaluate growth problems?
The first thing parents should do if they're worried about their child's growth is take the child to a pediatrician or another healthcare provider. First, the healthcare provider will decide whether the child's size or growth curve is a cause for concern. If it is, a series of possible causes of short stature and growth failure must be considered and your child may be referred to an endocrine specialist.

The healthcare provider may need to measure your child's height over a period of 6 to 12 months to evaluate the child's current growth rate. These measurements should be plotted on a pediatric growth chart along with as many earlier measurements as possible. Your child's healthcare provider or school often will have records of yearly height and weight measurements.

Working with your healthcare provider
The healthcare provider may ask questions about your child's current health, diet, appetite, and habits, and past illnesses and injuries. The healthcare provider will also ask for information about the mother's pregnancy, labor, and delivery, because these may provide a clue to the cause of the child's short stature. Questions about your child's progress in school, general mood, and home life are important in getting to know your child as a person, but also may shed light on your child's growth problem.

The healthcare provider will ask about the health of other family members, and will want to know the heights of parents, grandparents, siblings, and other close relatives. Be sure to tell the healthcare provider about any diseases or problems that run in the family, as well as about any history of early or late puberty (growth spurt and sexual development) in family members.

X-Rays and scans
X-rays or scans may be done to check on the condition of the pituitary gland (a small gland attached to the base of the brain). Blood tests can inform the healthcare provider about the condition of the kidneys, bones, and thyroid gland. The amount of insulin-like growth factor I (IGF-I; somatomedin) in the blood may also be checked. This is a substance that provides an indirect measure of the amount of growth hormone in the body.

An X-ray of the child's hand and wrist may be taken to check the child's bone age. In some short children, the maturity of the bones lags behind the child's actual age, and the child is said to have a delayed bone age. The bone age may be delayed for a variety of reasons, so it is not very helpful in finding the cause of short stature. It is, however, useful in determining a short child's growth potential, and this is one instance in which delayed maturity is a good sign. A 9-year-old boy who has a bone age of 7 years, for example, has about 2 years more growth potential, or room to grow, than the average 9-year-old. This is because the development of his bones is more like a 7-year-old boy's than like a 9-year-old's. However, this child's delayed bone age can "catch up" to his chronological age in less than 2 calendar years, especially after he enters puberty. Some of the changes that occur with the development of bones throughout childhood are shown in X-rays.

Predicting Adult Height
By referring to a special chart, the healthcare provider can predict an approximate adult height based on the child's current bone age and height. It's important to remember that these predictions are only educated guesses, and that the child's adult height will be the result of many factors, including the parents' heights, the child's general health and state of nutrition, the age at which puberty begins, and the length and vigor of the pubertal growth spurt. In general, height predictions are more reliable as the child becomes older.

Tests for growth hormone secretion
Stimulation testing for growth hormone secretion may be performed after other causes of growth failure have been considered and ruled out. Growth hormone is secreted by the pituitary gland in quick bursts and does not last long in the bloodstream, so checking a single blood sample is not likely to be helpful. The amount of growth hormone in the bloodstream is measured by taking one or more small blood samples over a period of time. This may be done in the healthcare provider's office or during a brief hospital stay. The results of these tests will indicate whether the child's growth problem is caused by a deficiency of growth hormone.

The amount of testing that a child needs depends on what the healthcare provider finds at each step of the evaluation. A short child who is healthy and growing at a normal rate may be observed periodically throughout childhood, while a child whose growth has stopped will need more involved testing. The evaluation process may make more sense if we take a closer look at some of the variations in the normal growth pattern and some of the causes of abnormal growth.


Frequently Asked Questions
As a parent of a child who has been diagnosed with pediatric growth hormone deficiency and may be about to start Primatropin therapy, you may have a number of questions. While you should always make it a point to discuss any concerns with your healthcare provider, you may find the following questions and answers to be a valuable starting point to your research.

What is growth hormone?
Growth hormone (often referred to as hGH, or simply GH) is a protein that, among other things, tells a child's body to grow. It is produced by the pituitary gland (an organ about the size of a pea, located at the base of the brain) and is released into the bloodstream.

What does growth hormone do?
As its name suggests, growth hormone is the chief hormone responsible for growth. It stimulates the development of muscles and bones, and also helps regulate metabolism. Growth hormone travels to the cartilage, then causes the cartilage to grow and turn into bone. It is also involved in the production of muscle protein and in the breakdown of fats.

In adults, as well as in children, growth hormone is essential to the maintenance of healthy body composition and metabolism. Throughout adulthood, growth hormone plays an important role in maintaining an improved ratio of body fat to lean mass, "bad" to "good" cholesterol levels, and proper bone mineral density.

What is pediatric growth hormone deficiency?
Pediatric growth hormone deficiency (PGHD) occurs when the production of growth hormone is disrupted during infancy or childhood. Essentially, it occurs when the pituitary gland of an infant or a child fails to produce growth hormone, or secretes inadequate amounts of the hormone.

How is pediatric growth hormone deficiency diagnosed?
Pediatric growth hormone deficiency is diagnosed through special blood tests that detect growth hormone in the blood.

What are the effects of pediatric growth hormone deficiency?
The decreased levels of growth hormone associated with pediatric growth hormone deficiency may result in abnormalities of many body processes—including growth and development, production of muscle protein, and breakdown of fats.

Is pediatric growth hormone deficiency very common? What causes it?
Although pediatric growth hormone deficiency is uncommon, it may occur at any time during infancy or childhood, and there are many possible causes. Some involve damage to the pituitary gland or the hypothalamus, a part of the brain that controls the pituitary.

What are the signs of pediatric growth hormone deficiency?
A major sign of pediatric growth hormone deficiency is a marked slowing of growth, usually to less than 2 inches (5 cm) a year. Many children with growth hormone deficiency have normal body proportions and normal intelligence, although some may be overweight for their height or have problems with low blood sugar.

What treatments are available for pediatric growth hormone deficiency?
Pediatric growth hormone deficiency is treated by giving the patient injections of growth hormone until he or she reaches his or her adult genetic potential height or until the growing ends of the bones fuse.

 

 

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