Growth hormone deficiency in children

Growth hormone deficiency means the pituitary gland does not make enough growth hormone.


The pituitary gland is located at the base of the brain. This gland controls the body’s balance of hormones. It also makes growth hormone. This hormone causes a child to grow.
Growth hormone deficiency may be present at birth (congenital). Or it may be the result of medical condition. Severe brain injury may also cause growth hormone deficiency.
Children with physical defects of the face and skull, such as cleft lip or cleft palate, may have decreased growth hormone levels.
Most of the time, the cause of growth hormone deficiency is unknown.

Symptoms
Slow growth may first be noticed in infancy and continue through childhood. The pediatrician will usually draw the child's growth curve on a growth chart. Children with growth hormone deficiency have a slow or flat rate of growth. The slow growth may not show up until a child is 2 or 3 years old.
The child will be much shorter than most children of the same age and gender. The child will still have normal body proportions though body build may be chubby. Often the child’s face looks younger than children of the same age. The child will usually have normal intelligence.
In older children, puberty may come late or may not come at all, depending on the cause.

Exams and Tests
A physical examination, including weight, height, and body proportions, will show signs of slowed growth rate. The child will not follow the normal growth curves.
Hand x-ray can determine bone age. Normally, the size and shape of bones change as a person grows. These changes can be seen on an x-ray and usually follow a pattern as a child grows older.
Testing is usually done after the  pediatrician has looked into other causes of poor growth. Tests that may be done include:
Growth hormone causes the body to make insulin-like growth factor (IGF1) and insulin-like growth factor binding protein 3 (IGFBP3). Tests can measure these growth factors.Accurate growth hormone deficiency testings involves a stimulation test. This test takes several hours.
MRI of the head can show the hypothalamus and pituitary glands.
Tests to measure other hormone levels may be done because lack of growth hormone may not be the only problem.

Treatment
Treatment involves growth hormone shots (injections) given at home. The shots are usually given once a day. Older children can often learn how to give themselves the shot.
Treatment with growth hormone is long-term, often several years. During this time, the child needs to be seen regularly by the doctor to ensure treatment is working and to change the dosage of the medicine if needed.
Serious side effects of growth hormone treatment are rare. Common side effects include:

    Headache
    Fluid retention
    Muscle and joint aches
    Slippage of the bones at the hip

The earlier the condition is treated, the better the chance that a child will grow to near-normal adult height. Many children gain 4 or more inches over the first year and 3 or more inches during the next 2 years. The rate of growth then slowly decreases.