Walgreens Specialty Pharmacy > Conditions and therapies > Growth hormone deficiency
Growth hormone deficiency
PrintA sufficient quantity of growth hormone is required during childhood to maintain growth and normalize sexual maturity. Children with GHD may experience growth retardation, short stature, and other maturation delays. Growth hormone continues to be produced throughout adulthood and is important in metabolism, proper body composition, mental well-being, and quality of life.
A deficiency occurs when the pituitary “master” gland produces little or no growth hormone. Growth hormone deficiencies may occur alone or in combination with other abnormalities. GHD can occur as a result of abnormal formation of the pituitary gland (congenital) or damage to the pituitary gland during or after birth in any stage of childhood or adulthood (acquired).
Select any question to learn more about growth hormone deficiency below:
What are the statistics for GHD?
What causes growth failure in children and adolescents?
What are the symptoms of GHD in children and adolescents?
How is GHD diagnosed in children and adolescents?
What is the treatment for GHD in children and adolescents?
What are the psychological effects of GHD in children and adolescents?
What is adult growth hormone deficiency (AGHD)?
What are the symptoms of AGHD?
How is AGHD diagnosed?
What is the treatment for AGHD?
Is there a cure for GHD?
Can GHD be prevented?
Where can I find GHD support groups in my area?
About Our Specialty Pharmacy
General References
What are the statistics for GHD?
The exact number of children and adults who have growth hormone deficiency is unknown. In the United States, it is estimated that about 20,000 children and 35,000 adults have GHD. Annually, 4,000 children and 6,000 adults are diagnosed with GHD.
What causes growth failure in children and adolescents?
Growth failure may occur as a result of growth hormone deficiency or in combination with one or more other medical problems. Low levels of certain hormones such as thyroid hormone and too much or too little sex hormones (testosterone and estrogen) can affect the growth of children. The thyroid gland produces thyroid hormone, which controls the speed of the body’s chemical functions (metabolic rate). When the thyroid cannot produce adequate amounts of hormone for the body, hypothyroidism develops. If this condition begins in childhood, it will slow growth as well as affect other bodily functions.
In young boys with high levels of male sex hormones, growth speeds up. However, because higher levels of these sex hormones cause bones to mature faster than normal and finish growing sooner, a child’s final height may be below normal. The male testes, which make the male sex hormone testosterone, sometimes can be underactive (hypogonadism). When the ovaries become underactive in females, such as a result of Turner syndrome, they produce decreased amounts of estrogen. Underactivity of the sex hormones (testosterone and estrogen) can result in delayed physical growth and sexual development in children.
Many diseases and disorders can cause growth failure in children. Diseases of the kidneys, lungs, and heart may lead to growth failure as a result of inadequate nutrition or a buildup of waste products and chemicals in the body. These may include the following:
Diabetes
- Children with diabetes may grow slowly, particularly when their blood sugar is not kept near the normal range.
Chronic Renal Insufficiency (CRI)
- CRI is a permanent decline in kidney function that also can lead to growth failure.
- Children with CRI produce a normal amount of growth hormone, but their body does not properly use the growth hormone they make.
Turner Syndrome
- This is a genetic disorder caused by the complete or partial absence of one of the two X chromosomes normally found in women.
- Turner syndrome exclusively affects girls and women.
- Diagnosis is done by a special blood test (called a karyotype) to look for damaged or missing sex chromosomes.
Prader-Willi Syndrome
- This is a genetic disorder caused by a deletion in several genes on chromosomes typically from the father.
- Prader-Willi syndrome results in short stature, decreased muscle tone, hypogonadism (impaired functioning of the testes or ovaries), learning disabilities, small hands and feet, and a chronic feeling of hunger.
Nutritional Deficiencies
- Intestinal disorders may lead to poor absorption of food.
- Treatment of these conditions often involves a special diet.
- Normal growth usually resumes after the condition has been treated.
Sometimes a cause for GHD or growth failure can not be identified, or if a cause is suspected, it may be difficult to prove. Researchers are trying to learn more about the causes of growth hormone deficiency.
What are the symptoms of GHD in children and adolescents?
Children with GHD may display short stature from birth onwards, or the condition may not become evident until some time later. Both parents may be of normal height or one also might be lacking in stature, possibly also due to GHD. If growth failure has been present for a long time, the child may be much shorter than other children of the same age. Short stature often is the only symptom present for many children with GHD. A child with GHD also may have an immature face and chubby body build. The rate of growth of all body parts is slow, so the child’s proportions remain normal. Excessive body fat and slow growth of hair and fingernails are additional characteristics of GHD. Typical symptoms that appear in babies are persistently low blood sugar and prolonged jaundice (yellowish skin color).
How is GHD diagnosed in children and adolescents?
All children should have their height and weight plotted on a standard growth chart as part of routine checkup visits with their physician. Children who are only as tall as other children two or more years younger than they are or whose growth rate slows down from a previously normal growth curve may require further testing for GHD. A pediatric endocrinologist or a physician who specializes in treating children with growth and hormone problems should be consulted to diagnose GHD.
What is the treatment for GHD in children and adolescents?
Growth hormone therapy requires a long-term commitment by the child and his or her family in order to achieve the best possible outcomes. The disorder is treated with injections of growth hormone. Children receive their injections either daily, or three to six days per week. The dose of growth hormone is individualized for each patient and is dependent on the child’s weight and diagnosis.
The medication most often is given by subcutaneous injection (under the skin) in the buttocks, thighs, or abdomen. Since the body naturally produces growth hormone in the evenings, this also is when injections typically are administered.
Most children will grow two to three times their pretreatment growth rate during the first year of therapy—an average rate of two to four inches during the first year. This increased rate will decline over time, but most children will grow an average of two inches each consecutive year until they reach puberty. Growth hormone therapy also promotes the growth of muscles, which grow proportionately with the bones. After treatment begins, many parents notice an increase in the child’s appetite and loss of body fat.
Increased growth will continue until epiphyseal fusion (when the bones come together) occurs. At this point, continued growth for any child ceases. Children usually are treated with growth hormone for several years until they reach their full growth potential or until no further benefits from the medication are seen.
As with other conditions, children and parents may become impatient to see faster or more impressive results from therapy. They may become discouraged, even when treatment is going according to plan. It is important to remember that growth is a slow process that is measured over months. Children (or parents) who expect the growth to occur overnight will be disappointed. Your child’s doctor will discuss realistic short- and long-term expectations of therapy with you.
Remember: Good nutrition and adequate rest also are important for normal growth in all children, and even more so in children with GHD.
What are the psychological effects of GHD in children and adolescents?
An increased growth rate, more mature appearance, and the hope for an adult height within the normal range are viewed as positive results of growth hormone therapy by both parents and children. However, parents need to consider some cautionary factors when their child undergoes treatment. According to experts in the field, some children might expect too much from their therapy, such as thinking they will grow overnight or become the tallest in their class. When these expectations are not met, the child may feel disappointed, depressed, or even guilty. Other children may feel a sense of “loss” when they begin to grow. They may regret losing the special niche or role they have developed in the family or at school by being smaller. Some children may not feel they are “special” anymore because they have begun to look like everyone else. A child also may feel uncomfortable about his or her growing body because it is unfamiliar.
According to some professionals treating families of growth hormone patients, a child’s growth problem may be an “excuse” to disguise other behavioral problems. Any problems the child has had are assumed to stem from the stresses of being short. When the child begins to grow, old behavior problems may persist or new ones may develop. Although self-esteem and body image may improve as the child begins to catch up to peers in size, growth hormone therapy does not cure behavior problems or remove all the child’s stress.
What is adult growth hormone deficiency (AGHD)?
Clinical evidence indicates that adults still need adequate levels of growth hormone to maintain healthy body composition and metabolism. Only recently have the problems associated with GHD in adults been brought to the forefront of medicine.
The amount of growth hormone released by the pituitary gland over a person’s lifetime decreases with age. When growth hormone is released into the bloodstream, tissue absorption occurs to maintain a healthy balance within the muscles, bone, and fat tissue. It is very difficult to recognize GHD in adults since the maximum height has been attained and the bones are fused. In a deficient state, an adult body does not maintain a proper balance of fat, muscle, and bone. Fat is deposited more readily, while muscle and bone face deterioration.
What are the symptoms of AGHD?
A number of symptoms may indicate AGHD, including:
- weakened heart muscle contraction and heart rate
- increased arterial plaque and blood pressure
- elevated fats in the blood:
- cholesterol
- low-density lipoproteins (LDL)
- triglycerides
- decreased exercise capacity due to decreased metabolic rate
- abnormal body composition:
- increased abdominal obesity (waist-to-hip ratio)
- decreased bone density due to decreased bone synthesis
- increase in fractures and osteoporosis
- decreased muscle strength and muscle size
- decreased lean body mass
- increased fat mass
- problem with the quality of sleep
- decreased social contact
- low blood sugar symptoms:
- weakness or tiredness
- headaches
- poor concentration or memory
How is AGHD diagnosed?
Diagnosis of AGHD may be preceded by a history of childhood GHD or a history of organic pituitary or hypothalamic disease. The most common cause of AGHD is damage to the pituitary gland, which may be a result of trauma, a tumor, or surgery or radiation. Deficient adults with no signs or history of tumors initially are treated for symptoms, such as depression. However, this does not correct the underlying cause of the deficiency, and a proper diagnosis may take time. A test that provokes the pituitary to release growth hormone, called a “stimulation test,” is used to diagnose GHD in both adults and children. Adults with a deficiency in three or more pituitary hormones may not require stimulation testing for an adequate diagnosis. A clinical endocrinologist, or physician who specializes in treating adults with growth and hormone problems, should be consulted to diagnose AGHD.
What is the treatment for AGHD?
Once a diagnosis of AGHD has been made, the patient administers regular injections of growth hormone. Many of the same medications used for pediatric patients also are given to adults. Adults are more susceptible than children are to side effects from growth hormone therapy. Adult dosages of growth hormone are smaller than those used for treating children. The main treatment goals of growth hormone therapy include the restoration of normal body functions, including energy, metabolism, and body composition. After undergoing therapy, adult patients may have increased energy, a reduction of fat tissue, and more positive mood.
Is there a cure for GHD?
At present, there is no cure for GHD. The primary treatment for GHD is injections of growth hormone.
Can GHD be prevented?
Most cases of GHD are congenital, which means the child is born with that particular condition. A physician-recommended diet to satisfy the nutritional needs of a growing child often can reverse growth failure caused by nutritional deficiencies.
Where can I find GHD support groups in my area?
The MAGIC Foundation can put you in touch with support groups in your area that consist of patients and others who might share your interest and concerns about GHD. Contact the MAGIC Foundation at 1-800-3-MAGIC-3 or 1-708-383-0808, or reach them on the Internet at http://www.magicfoundation.org.
About Our Specialty Pharmacy
It is important to find a pharmacy that understands the complexities of growth hormone medications. Walgreens Specialty Pharmacy was created to take some of the time-consuming tasks of medication management off the hands of the growth hormone patients or their caregivers. Walgreens specially trained pharmacists join your treatment team, working closely with your physician and other healthcare providers, to support their services and help ensure you get the most from their growth hormone therapy.
General References
Pediatric Endocrinology Nursing Society
www.pens.org
The Human Growth Foundation
www.hgfound.org
The MAGIC Foundation
www.magicfoundation.org
Turner Syndrome Society of the United States
www.turner-syndrome-us.org
Inclusion of resources on this list does not imply endorsement by Walgreen Co. or any of its subsidiaries or affiliates. These resources should be used for general information and educational purposes only. Information provided by these resources should not replace necessary medical consultations with a qualified health or medical professional.
This publication does not constitute professional medical advice. Although it is intended to be accurate, neither Walgreen Co., its subsidiaries or affiliates, nor any other party assumes liability for loss or damage due to reliance on this material. If you have a medical question, consult your medical professional.