Treatment of children and adolescents with growth hormone for idiopathic short stature (ISS) is controversial for two reasons. First, the response to growth hormone is highly variable, probably because of the heterogeneous endocrinologic profile in children with ISS, and those children who respond to growth hormone treatment may have only modest increases in linear growth. Second, there is little evidence that short stature represents a substantial psychosocial burden to most short children. The possible psychosocial benefit must be weighed against the substantial cost and possible adverse effects of treatment.
The efficacy and potential risks of growth hormone and alternative treatments for children with ISS are discussed below. The clinical evaluation of children with short stature is discussed separately. (See “Diagnostic approach to children and adolescents with short stature” and “Causes of short stature”.)
For example, a lack of consistency or directness will weaken the strength of the evidence. Normal exam, lab studies (incl renal, CBC, thyroid, & IGF-I for bone age). Decisions for treatment are based on the potential benefits, he said, and careful examinations to find the appropriate candidates. The baseline characteristics of height, BMI, and BA-CA showed no significant differences between the iGHD and ISS cohorts. Messi was using a prescribed treatment, monitored by physicians, in order to overcome a medical condition. It is estimated that approximately 3,000 GHD patients were treated with pituitary-derived hormone in the US in 1985. Growth Horm IGF Res. 18 Similarly, the difference between adult height of GH-treated and control groups was 0.78 to 0.84 SD, or 5 to 6 cm (range, 2.3-8.7 cm).
Its author (Mller) makes the claim that new clinical and scientific evidence shows that GH-RH can be used to study the physiological pathways which encourage healthy Human Growth Hormone production, but the HGH precursor is not useful as a test for discovering an active state of Human Growth Hormone Deficiency. Endocr Pract. Lieberman SA, Hoffman AR. Growth hormone deficiency in adults: Characteristics and response to growth hormone replacement. Parents rate concerns about the impact of short stature on psychosocial function, both current in childhood and projected into adulthood, as strongly influencing their decision to seek medical care for a child’s short stature 14 Likewise, 18% of subjects in all 4 U.S. hGH registries combined were treated for ISS 15 , i.e. for psychosocial, not health, reasons.
Use: Treatment of idiopathic short stature (ISS), also called non-GHD short stature, defined by height SDS lower than -2.25, and associated with growth rates unlikely to permit attainment of adult height in the normal range, in pediatric patients whose epiphyses are not closed and for whom diagnostic evaluation excludes other causes associated with short stature that should be observed or treated by other means. Indian J Endocrinol Metab. To what extent should private insurance or government funds be expected to support the treatment of short stature? Adult growth hormone (GH) replacement: The use of somatotrophin (GH) in the management of adult somatotrophin deficiency. Post-approval studies are therefore important to provide safety and efficacy data in extrapolated indications.
Growth Hormone Therapy: Treatment for ISS
Growth hormone therapy refers to the use of growth hormone (GH) as a prescription medication —it is one form of hormone therapy Growth hormone is a peptide hormone secreted by the pituitary gland that stimulates growth and cell reproduction. Idiopathic short stature is commonly defined as height below the third percentile or about two standard deviations (SD) or more below the mean height for a given age, sex and population group. Approximate untreated adult height (in cm) for males with ISS ranges from 157 cm to 170 cm, compared with a mean of 178 cm for normal males (2 SD below the mean being 164 cm); untreated adult height for females with ISS ranges from 137 cm to 156 cm, compared with a mean of 164 cm for normal females (2 SD below the mean being 152 cm) ( Price 1996 ; Preece 2000 ).
In addition to gaps regarding outcome measures, significant limitations persist in the ability to clearly identify which patients have GHD or PIGFD. The new PES guidelines highlight the hazards of relying on discrepant, non-harmonized GH assays and GH provocative tests and IGF-I generation tests for distinguishing patients with GHD or PIGFD, respectively. These limitations continue to hamper advancement in evidence-based practice for hGH treatment.
There is also the question of how to define treatment ‘success’. Short stature is a characteristic that must be defined relative to the general population in which people will always be of different heights. Thus, even if GH therapy were available to and effective in all ‘short’ stature children, a population of short children will still exist; they will simply be a few inches taller than those in the former population”.
Pfizer Medical Information
Human Growth Hormone was first discovered in 1956 and its structure was identified in 1972. Conclusions Treatment with GH results in short-term increases in growth for children with idiopathic short stature, and long-term GH can increase adult height. These results are fundamental to decisions about GH use and raise questions about the goals of treatment. Use of GH for idiopathic short stature in clinical practice will depend on its efficacy in promoting growth and the value of this effect to families, physicians, and third-party payers.
Leschek EW, Rose SR, Yanovski JA, Troendle JF, Quigley CA, Chipman JJ, Crowe BJ, Ross JL, Cassorla FG, Blum WF, Cutler GB, Baron J, National Institute of Child Health and Human Development-Eli Lilly & Co: Effect of growth hormone treatment on adult height in peripubertal children with idiopathic short stature: a randomized, double-blind, placebo-controlled trial. J Clin Endocrinol Metab. 2004, 89 (7): 3140-3148.
GH injections are quick and almost pain-free, so children ages 10 and up may be able to and often prefer to give themselves their own injections. It is important that a parent supervises the injection to make sure the child gives the correct dosage each day. Parents should give the injections to younger children. Because natural growth hormone is released mainly during sleep in children, GH treatment is more effective when taken at bedtime.
However, the unlimited availability of rhGH increased the potential for its misuse; as an anabolic agent by athletes, as a ‘supposed’ anti-ageing agent, and in children who are not short by definition but falling short on parents’ expectation of stature. Lack of a simple one point robust test for diagnosing GH deficiency, compounds this problem further 3. Erroneous interpretation of a random GH level as low by a physician leaves room for unwarranted prescriptions.
Although there is no definitive test for Secondary HGH Deficiency, IGF-1 Testing is the most accurate means to diagnose the disorder. In order to most accurately diagnose HGH Deficiency it is necessary to take a blood test in which a full panel of hormone tests will be administered to ensure that there are no other underlying disorders or issues which may be creating symptoms similar to that of HGH Deficiency. In addition to this, the patient must be experiencing the symptoms of HGH Deficiency. As is true with many hormonal disorders, it is ultimately up to the clinical judgment of the physician to ultimately diagnose the disorder.
The benefit in adult height gain (that corrects for differences in baseline heights) of our treated children were higher than the adult height gain of the controls in the published studies by 1.26 SDS and 1.56 SDS for the NFSS (8.5 and 10.5 cm for males and 7.7 and 9.5 cm for females) and 1.21 SDS and 1.6 SDS for the FSS (8.1 to 10.8 cm for males and 7.4 to 9.8 cm for females); an equal benefit for children with NFSS and FSS.