Growth hormone deficiency (patient information)

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 * Associate Editor(s)-In-Chief: Suvekchha Devkota, M.D, Jinhui Wu, M.D.

Overview
Growth hormone is a very important hormone in our whole lives. It is needed for children's growth and for adults to keep bodies in proper balance. Without growth hormone, chidren show signs of delayed growth in height and weight. As in adults with growth hormone deficiency, they may demonstrate more fat, less muscle and less bone structure, even less mental functions and social activities. Growth hormone deficiency may be caused by some reasons, such as mutations of specific genes, congenital dysfunction of hypothalamus or pituitary, tumor, surgery or radiation therapy for brain tumor, head injury or trauma, etc. Doctors may get disgnosis from growth hormone test, bone age tests and cranial MRI scan. Replacement of growth hormone in both children and adults may help children reach a normal adult height and adults keep the body to a healthy balance..

What are the symptoms of growth hormone deficiency?
In the past, people thought growth hormone deficiency may affect only in children. Until recently, few people realized the importance of growth hormone to an adult body.
 * Growth hormone deficiency in children
 * Many children with growth hormone deficiency grow normally until the age of two or three and then begin to show signs of delayed growth about 2 inches a year.
 * They may have low weight than their peers, although some on the higher percentile in weight.
 * These children have normal body proportions and look younger than their peers.
 * Growth hormone deficiency in adults
 * More fat: With this deficiency, fat is deposited more easily around the middle of the abdomen.
 * Less muscle: Since growth hormone affects muscles, patients with growth hormone deficiency may feel less muscle and less ability to exercise.
 * Less bone structure: Patients with growth hormone deficiency may occur weakening osteoporosis.
 * Less mental functions and social activities: Most growth hormone deficiency adults notice a decrease in their energy level and endurance for exercise. They may avoid social contact, even avoid meeting with or talking to their friends. Some patients may have deficient interest in sexual activity. Some may show the sign of hypomnesia.

Who is at highest risk?

 * Mutations of specific genes
 * Congenital dysfunction of hypothalamus, pituitary
 * Any damage to pituitary, such as tumor, surgery or radiation therapy for brain tumor,
 * Head injury or trauma
 * Ischemic or hemorrhagic infarction from low blood pressure (Sheehan syndrome), or hemorrhage pituitary apoplexy.

Diagnosis

 * Growth hormone test and a stimulation test: Growth hormone level will show whether the growth problem is caused by a problem with the pituitary gland. Further more, a stimulation test can confirm the diagnosis of growth hormone deficiency. During the stimulation test, the blood growth hormone is measured at intervals after a stimulust such as arginine, L-dopa, clonidine or insulin. In normal individuals, there is a rise in blood growth hormone after a stimulus. But in patients with growth hormone deficiency, no rise or an insufficient rise.
 * A bone age test: For children suspect growth hormone deficiency, dual energy x-ray absorptiometry (DEXA) scans can be used to determine bone age.
 * Cranial MRI: Some brain tumor or injure may cause growth hormone deficiency, cranial MRI scan is necessary. This test may show whether there is abnormal in hypothalamus and pituitary glands.

Diseases with similar symptoms
For children, they need to differ from: For growth hormone deficiency adults, differential disgnosis includes:
 * Dwarfism
 * Cretinism
 * Depression
 * Brain tumor
 * Obesity

When to seek urgent medical care?
Call your health care provider to identify the cause of growth hormone deficiency if your child seems abnormally.

Treatment options
Early treament after diagnosis is very important. Treatment protocol is growth hormone therapy. It is given by injection underneath the skin into fat tissues, either daily or several times per week. The dose of growth hormone depends on your responses and blood tests taken to monitor therapy. Doctors will calculate the proper dose for you. After treatment, most children will reach a normal adult height or nearly their full growth potential and adults will restore the body to a more normal and healthy balance.

Where to find medical care for growth hormone deficiency?
Directions to Hospitals Treating growth hormone deficiency

What to expect (Outook/Prognosis)?
Prognosis of growth hormone deficiency depends on:
 * When to start to treat the children: The earlier the condition is diagnosed and treated, the better the chance may be for the child.
 * Patients' reaction to growth hormone replacement therapy: Some children get good reactions to growth hormone replacement therapy. But it seems the treatment does not work in other children.

Prevention of growth hormone deficiency
Preventive measure for growth hormone deficiency is unknown.