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Growth Hormone Deficiency

E-Newsletter No. 70

What is growth hormone?
Hormones are chemical messengers carried through the bloodstream that cause changes in different areas of the body.
Growth hormone is one of many hormones produced by the pituitary, a small gland at the base of the brain. In children,
growth hormone is mainly responsible for development and growth. In adults, growth hormone has other important actions
that regulate body composition and function.

Who has growth hormone deficiency and why does it occur?
About 50,000 adults have growth hormone deficiency (GHD) in the United States. GHD occurs at a rate of about one case
per 3,500 children.\

A child may have GHD for many reasons. Some children are born with conditions that cause problems with growth hormone
production. Others experience an illness or trauma that damage part of the pituitary or another part of the brain. Many
children have GHD for unknown reasons. Various degrees of deficiency can occur, ranging from partial to complete lack of
growth hormone. Some children who take growth hormone do not have a growth hormone deficiency, but instead have one
of many other conditions that result in slowed growth (e.g., chronic kidney disease, Turner syndrome, Prader-Willi
syndrome, or Noonan Syndrome).

Adult GHD occurs when the pituitary gland does not release enough growth hormone. Common causes of GHD in adults are
brain trauma, a pituitary tumor, or treatment of the pituitary tumor with surgery or radiation.

What other conditions are treated with growth hormones?
Besides using growth hormones to treat GHD, certain growth hormones are used to treat conditions such as Short Bowel
Syndrome and HIV-associated wasting.

Short Bowel Syndrome occurs when you have a decrease in bowel (intestine) length or function and cannot absorb enough
nutrients from food into your body. Growth hormone, when used witll a special diet, can help your bowel take in more water,
electrolytes, and nutrients from food.

HIV-associated wasting (or cachexia) commonly involves involuntary loss of lean body mass or body weight. People who are
infected with HIV tend to use their lean body mass for energy instead of using their body fat. If you lose too much of your
lean body mass, you can become weak and your organs may fail. Growth hormone has been shown to increase weight, lean
body mass, and physical endurance in people with HIV cachexia.

What are the symptoms of growth hormone deficiency?
All children grow and mature at different rates. Children with GHD do not grow as fast or as much as others. Some newborn
babies with GHD experience prolonged jaundice (yellowish skin color) or low blood sugar. Often, the only symptom of GHD
in older children is very short height. Some children may have difficulty coping with their delayed growth and maturation.
Others may have difficulties with feeling as though they are different than their peers.

Adults with GHD may have any of the following symptoms:
- Increased fat mass
- Reduced muscle mass, strength and energy
- Smaller heart and decreased heart function
- Lower bone density
- High cholesterol levels
- Depressed mood
- Thin, dry skin
- Increased social isolation

What can you expect from treatment with growth hormone?
Response to growth hormone therapy varies in each individual child. Children who are younger or have more severe GHD
will respond better to treatment. In most children taking growth hormone, the largest increases in height usually occur during
the fIrst two years of treatment. Children taking growth hormone usually grow an average of three to four inches in the fIrst
year of treatment. The growth rate usually slows in the following years, but children taking growth hormone still grow faster
than they would without it. Be sure to remind your child that growth is a slow process and that it takes time to see any
noticeable increases in height.

In adults, therapy with growth hormone is useful to reverse the changes in body composition that accompany GHD. Growth
hormone therapy has been shown to:
- Increase bone density and muscle mass
- Improve mood and heart function
- Improve cholesterol levels
- Decrease total body fat
- Increase quality of life

The response to growth hormone therapy varies with each adult. Most adults see improvement within several months of
starting treatment. The benefits of therapy in adults have been shown to last when treatment is continued for many years.

Is growth hormone therapy safe?
In children, growth hormone therapy has been shown to be very safe. Side effects are rare and may include muscle or joint
pain, breast growth, water retention, and headaches. Pain at the injection site may also occur. Be sure to let the doctor know if
your child has knee pain, hip pain, or frequent headaches while taking growth hormone. These may be signs of a more
serious problem.

In adults, growth hormone therapy has also been shown to be safe. Doctors usually start adult patients at a low dose and
gradually increase it as tolerated. The most common side effects in adults include water retention, muscle or joint pain, and
carpel tunnel. These symptoms usually occur when treatment is first started or when the dose is increased. Older, obese, or
female adults are more likely to experience side effects. Symptoms tend to improve after several weeks of treatment. Contact
your doctor if you are having side effects or problems injecting your medication. The doctor can help you manage the side effects 
or teach you medication injection techniques. If side effects persist, please consult your doctor. Growth hormone can have a 
negative effect on blood sugar levels. Adults taking growth hormone who are obese, have diabetes, or have a family history of 
diabetes should be monitored closely. Patients with active tumors should not receive growth hormone therapy.

Should growth hormone be given while a child is ill?
Growth hormone injections can be continued if your child has a minor illness or cold. The fewer doses your child misses, the
more successful therapy is likely to be. If your child has a more severe illness, ask your child's doctor whether growth
hormone therapy should be continued. In addition, children with active tumors should not receive growth hormone therapy.

How long do you need to take growth hormone?
For children, the length of growth hormone therapy differs in each individual child. Your child's doctor will determine how
long treatment should continue. Growth hormone therapy is generally continued until a child reaches his or her adult height
and has stopped growing. Some patients with GHD may need to continue therapy as adults to optimize body composition and
heart function.

Many adults on growth hormone therapy may be treated long term. The amount of growth hormone your body needs may
change as you age. Your doctor will monitor your needs and adjust your dose as needed.

How should growth hormone be given?
Growth hormone is usually given as an injection under the skin or in a muscle, depending on which product you are using.
Injections are usually given on a daily basis. A dose every night is usually preferred because it most closely resembles the
body's normal growth hormone production. Your doctor will adjust your dose based on lab tests and any side effects you may
have. The site at which you inject growth hormone should be rotated on a daily basis to avoid creating a dimple or bump in
one specific area.

What if a dose is missed?
If you miss a dose of growth hormone, it may be given as soon as you remember. Occasional missed doses are not dangerous. 
Make sure to keep track of missed injections so your doctor can monitor the therapy's effectiveness.

How should growth hormone be stored?
Each growth hormone product has different storage requirements. Most products need to be kept in the refrigerator. Even
when kept cold, growth hormone products are stable for only a short period of time. Be sure to read the manufacturer's
directions regarding proper storage and use.

Therapy may be continued when you travel as long as the growth hormone is properly stored. Keep growth hormone cold
(but not frozen) in a cooler with ice packs. Keep the cooler with you on a plane or in a car, but don't check it as baggage
when flying. Please follow specific manufacturer directions for handling during travel.

Contact your doctor if you have questions on how to store the medication at home and when you travel.

What other resources are available?
The following Web sites are available for more information:
Human Growth Foundation 

The Magic Foundation

The Hormone Foundation 

1. American Association of Clinical Endocrinologists. Medical guidelines for clinical practice for growth hormone use in
adults and children. Endocrine Practice. 2003;9:64-76.
2. Colao A, di Somma C, Piconello R, et al. The cardiovascular risk of adult GH deficiency improved after GH replacement
and worsened in untreated GHD: a 12-month prospective study. J Clin Endocrinol Metab. 2002; 87(3):1088-93.
3. Carroll PV, Christ ER, Bengtsson BA, et al. Growth hormone deficiency in adulthood and the effects of growth hormone
replacement: a review. J Clin Endocrinol Metab. 1998;83(2):382-95.
4. Gibney J, Wallace ill, Spinks T, et al. The effects of 10 years of recombinant human growth hormone (GH) in adult GH-
deficient patients. J Clin Endocrinol Metab. 1999;84:2596-2602.
5. Growth Hormone Research Society. Consensus Guidelines for the Diagnosis and Treatment of Growth Hormone
Deficiency: summary statement of the Growth Hormone Research Society Workshop on Adult Growth Hormone
Deficiency. J Clin Endocrinol Metab. 1997;83(2):379-381.
6. Growth Hormone Research Society. Consensus guidelines for the diagnosis and treatment of growth hormone (GH)
deficiency in childhood and adolescence: summary statement of the GH Research Society. J Clin Endocrinol Metab.
7. Growth Hormone Research Society. Critical evaluation of the safety of recombinant human growth hormone
administration: statement from the Growth Hormone Research Society. J Clin Endocrinol Metab. 2000;86(5): 1868-70.
8. Lindsay R, Feldkamp M, Harris D, et al. Utah growth study: growth standards and the prevalence of growth hormone
deficiency. J Pediatr. 1994;125:29-35.
9. Monson JP. Long-tenn experience with GH replacement therapy: efficacy and safety. Eur J Endocrinol. 2003; 148 Suppl
10. Molitch ME, Clemmons DR, Malozowski S, et al. Clinical Practice Guideline: Evaluation and Treatment of Adult
Growth Hormone Deficiency: An Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab.2006;
11. Serostim@ prescribing infonnation. Rockland, MA: EMD Serono Inc; 2007.
12. ter Maaten JC, de Boer H, Kamp 0, Stuunnan L, van der Veen EA. Long-tenn effects of growth hormone (GH)
replacement in men with childhood-onset GH deficiency. J Clin Endocrinol Metab. 1999;84(7):2373-80. The Magic
Foundation. Psychosocial issues in delayed growth children. Available at: Accessed April 15, 2008.
13. Vance ML, Mauras N. Drug Therapy: Growth hormone therapy in adults and children. N Engl J Med. 1999;
341 (16): 1206-1699;84:2596-260.
14. Wilson T A, Rose SR, Cohen P, et al. Update of guidelines for the use of growth hormone in children: the Lawson
Wilkins Pediatric Endocrinology Society Drug and Therapeutics Committee. J Pediatr. 2003; 143:415-21.
15. Zorbtive@ prescribing infonnation. Rockland, MA: EMD Serono Inc; 2004.

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