Saturday, June 15, 2024
HomePediatrics: General MedicinePediatric Growth Hormone Deficiency

Pediatric Growth Hormone Deficiency

Practice Essentials

Presentation

History

The history in patients with suspected growth hormone deficiency (GHD) should focus on the following issues:

Birth weight and length: Intrauterine growth retardation is an issue in the differential diagnosis and should be apparent from the birth history.

Height of parents

Timing of puberty in parents

Previous growth points

General health of child: Exclusion of chronic disease as the cause of short stature is imperative.

Nutritional history: Malnutrition is the most common cause of short stature worldwide.

Physical

The following items should be targeted:

Height and weight measurement

The best way to evaluate height or weight measurements is to plot the points on a growth chart. A growth chart depicts the child’s growth over time, allows comparison of the height or weight to other children, and graphically depicts changes in growth or growth velocity.

Although weight is not difficult to determine, height measurement requires care.

Proportionality: Inspect the child for proportionality of limbs and trunk.

Pubertal status

Evidence of specific syndromes: Many syndromes include short stature as follows:

Turner syndrome

Noonan syndrome

Russell-Silver syndrome

Workup

Laboratory Studies

Laboratory studies in growth hormone deficiency (GHD) include the following:

Thyroxine and thyroid-stimulating hormone: Hypothyroidism should be excluded as a cause of growth failure and short stature.

Serum electrolytes: A low bicarbonate level may indicate renal tubular acidosis, which can result in growth failure. Abnormal electrolytes may indicate renal failure.

CBC count and sedimentation rate: These studies may be helpful if inflammatory bowel disease is suspected.

Insulinlike growth factor 1 (IGF-1) and IGF-binding protein 3 (IGFBP-3)

Karyotype

Celiac panel: Celiac disease may present with growth failure without specific GI complaints

Imaging Studies

Bone age: Radiograph of left hand and wrist is compared to standards and can be used to estimate skeletal maturation.

Patients diagnosed with growth hormone deficiency should undergo an MRI of the head to exclude a brain tumor (eg, craniopharyngioma). Approximately 15% of patients with growth hormone deficiency have an abnormality of the pituitary gland (eg, ectopic bright spot, empty or small sella).

Other Tests

Growth hormone response to insulin is the most reliable test for growth hormone deficiency.

Management

Medical Care

The current practice is a subcutaneous injection of growth hormone and daily administration is now commonly used. Long acting agents are currently still in the investigative phases. 

Although growth hormone is normally secreted in multiple peaks during the day and mostly at night, a single daily injection of recombinant growth hormone can provide physiologic replacement. In order for growth hormone replacement to be effective, other pituitary deficiencies should be treated. Response to growth hormone therapy is measured (every 3-6 mo) by sequential height determinations and by occasional bone age determinations.

See PresentationWorkup, Treatment and Medication for more detail.

RELATED ARTICLES
- Advertisment -

Most Popular