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Growth hormone deficiency is a disorder that involves the pituitary gland (a small gland located at the base of the brain), which produces growth hormone and other hormones. When the pituitary gland does not produce enough growth hormone, growth will be slower than normal. Growth hormone is necessary for normal growth and development in children. Growth hormone deficiency can occur at any age.
The child's growth pattern is an important part of determining normal growth. Normally, a child grows about 2 inches per year. A child with growth hormone deficiency usually has a growth pattern of less than 2 inches per year. In many cases, the child grows normally until he or she is about 2 or 3 years old; then, signs of growth delay begin to show. In other cases, the child may experience growth delay earlier or later than this age. Although much smaller, a child with growth hormone deficiency has normal body proportions (the relationship of one body part to another) and tends to look younger than other children of the same age.
Growth Hormone Deficiency Causes in Children
Growth hormone deficiency may be congenital (condition that is present at birth). The cause of congenital growth hormone deficiency may be associated with an abnormal pituitary gland, or it may be a part of another syndrome. Growth hormone deficiency may also be acquired (a condition obtained after birth). Acquired causes include trauma, infections, radiation to the head, and other diseases (eg, brain tumors). Apparent growth hormone deficiency may occur when the body is unable to respond to growth hormone. In this case, there are high levels being made by the pituitary gland and circulating in the blood, which are ineffective. This condition tends to run in families, but it may occur in an individual with no family history. In some cases, no cause can be found.
Growth Hormone Deficiency Symptoms in Children
A child with growth hormone deficiency may have the following symptoms:
Short height for his or her age
Increased amount of fat around his or her waist and in the face
Emotional or upset about his or her height or weight
The child may look younger than other children his or her age
Delayed onset of puberty
Delayed tooth development
When to Seek Medical Care
If you are concerned about your child's growth or height, talk to your doctor or health care practitioner. Your child's height and weight can be compared to normals for age and sex. In addition, if your child has had regular exams, the rate of growth can be easily evaluated. If there is an unusual pattern of growth and development, a consultation with a pediatric endocrinologist should be considered.
Exams and Tests
The doctor will ask about the patient's medical history. The doctor may also ask about the heights of the child's parents and other family members.
The doctor may ask about growth and maturation (the process of becoming fully developed) in family members.
The doctor may ask about the child's past growth patterns. These can be obtained from the doctor's office, schools, or even measurements taken at home.
The doctor may take measurements of the child's height and weight. The best way to evaluate height and weight measurements is to plot them on a growth chart. A growth chart shows the child's growth over a period of time. This allows the child's measurements to be compared with the measurements of other children that are his or her age.
The doctor or health care practitioner may perform tests to rule out other causes of growth delay.
Thyroxin and thyroid-stimulating hormone to test for hypothyroidism (decreased production of thyroid hormone)
Serum electrolytes to test for certain kidney conditions
A complete blood count
Insulinlike growth factor 1 (IGF-1) and insulinlike growth factor binding protein 3 (IGFBP-3) (proteins that depend on growth hormone)
X-rays may be obtained to check the child's bone size.
A test to check the child's growth hormone secretion may be performed. Insulin may be given by IV to stimulate growth hormone secretion. Measurements may be obtained over several hours.
A karyotype (a study of a person's chromosomes) may be performed in girls to rule out Turner syndrome.
Growth Hormone Deficiency Treatment in Children
Medications
Growth hormone deficiency can be treated with growth hormone replacement therapy. A drug called somatropin or growth hormone (Nutropin, Genotropin, Norditropin, Saizen, Humatrope) is injected into the fat underneath the skin. Shots are usually given daily. There is also a preparation of growth hormone (Nutropin Depot) that is designed to be given once or twice per month.
Surgery
Surgery is never an option for growth hormone deficiency on its own, but it may be considered if a tumor is present. Removal of the tumor may or may not have any effect on the secretion of growth hormone.
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