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Treatment Options for Growth Hormone Deficiency in Children

Your child's physical development may be impacted by a hereditary disease called paediatric growth hormone deficiency (PGHD). Growth promotion can be aided by hormone replacement therapy, which is now easier to administer thanks to a new injectable.

By secreting hormones, the pituitary gland controls growth, metabolism, and reproduction. A shortage in growth hormone (GH) is caused when the gland does not create enough of it, which typically leads to sluggish growth of bones and tissues.

The most obvious sign of post-ganglionic hypotrophy (PGHD) in children is frequently sluggish height growth or short stature.

Your child may be eligible for treatment if they have PGHD. Usually, they take the form of hormone replacement treatment.

Following diagnosis, treatment can start right away with recombinant human growth hormone therapy and hormone injections.


Recombinant human growth hormone (rhGH) replacement therapy

Recombinant human growth hormone (rhGH), a synthetic form of the growth hormone produced naturally by the pituitary gland, is used in hormone injections for post-gestational hydrocele (PGHD).

Known by most as somatropin, the medication consists of an artificial protein that attempts to closely resemble natural growth hormones. Consequently, it can promote linear (height) growth by stimulating the growth of both bone and tissue.

Additionally, rhGH can enhance metabolism. Until it is contraindicated, the therapy, which was initially approved by the Food and Drug Administration (FDA) in 1985, is still the first line of treatment for children with human growth hormone insufficiency.

A physician might advise against using growth hormone injections in the following circumstances:
  • a cancer that is actively spreading
  • a history of blockage of the airways
  • sleep apnea
  • severe obesity


How is the treatment administered?

Growth hormone is administered by subcutaneous injection. This indicates that the medication is injected into the fatty tissue that lies just beneath the skin's surface using a needle. When administered by automatic injection, it's a shallow injection that's advertised as almost painless.

Children's subcutaneous injection equipment has a unique pen-like casing. The drug is automatically injected into the body upon a button press. Children who are ten years old or older can frequently learn how to inject themselves with growth hormones.

The tops or outsides of the thighs, the backs of the arms, the outside quadrant of the buttocks, and the sides of the abdomen are among the body parts where a child can receive a rhGH injection. The majority of physicians advise switching up the injection sites each time.


How often are rhGH injections required?

Human growth hormone treatment is frequently prolonged, lasting several years. The experts advise administering a subcutaneous injection once daily throughout this period.

The injection is typically administered in the evening by medical personnel because children's sleep naturally releases growth hormones. Taking the rhGH injection right before bed, within an hour or so, increases its effectiveness.

The dosage may be increased by your child's physician over time. Somatropin is normally administered at a dose of 0.15 to 0.3 mg per day.

Every three to six months, appointments are made to check height and, if needed, modify the dosage.


How effective is rhGH therapy?

Studies have indicated that growth hormone treatment enhances children with PGHD's final height as well as their height velocity. It normally takes a few months for results to show up, starting about three to four months after injections start.

Growth brought on by rhGH therapy usually occurs in four stages:
  • starting phase (also known as the "catch-up phase," the first two to three years)
  • childhood growth phase
  • pubertal phase
  • final stage (at the point when your child reaches or approaches adult height)
Research has indicated that children with GH deficiency who get rhGH treatment grow 3–4 centimetres (cm) shorter than the family's desired height. If therapy is initiated later in childhood and there is insufficient time for catch-up development before puberty, the deviation from the familial goal height may increase.

Since each child is unique, it's crucial to remember that not all of them will benefit from growth hormone treatment.


Are there any side effects to growth hormone therapy?

It is rare for growth hormone therapy to have serious negative effects. Possible adverse consequences consist of:
  • muscle and joint aches
  • headaches
  • fluid retention
  • hip joints and bones slipping
  • insulin resistance
  • redness and discomfort where the injection was made

Possible future advancements in PGHD

Long-acting growth hormone (LAGH) is one of the most recent developments in the treatment of children with growth hormone insufficiency. LAGH injections require only one weekly administration, in contrast to conventional rhGH therapy.

Somatrogon-ghla (NGENLA), a long-acting growth hormone injectable for kids three years old and up, received FDA approval in 2023. Clinical research revealed that when compared to somatropin, it was as safe and effective. Research on LAGH injections is still a little bit scarce, though.

In certain cases, doctors may combine growth hormone injections with medications to inhibit puberty in children who have precocious (early) puberty or if rhGH is started too late. These kinds of drugs are referred recognised by doctors as gonadotropin-releasing hormone analogues, or GnRHa.

Studies have indicated that when patients got GnRHa in conjunction with rhGH, they gained an extra 6 to 9 cm of height throughout the adult phase. There hasn't been much research done on this, though.


The takeaway

The most popular treatment for paediatric growth hormone insufficiency is still daily injections of rhGH. Long-acting growth hormone injections, on the other hand, appear promising and can lower the frequency of doses from daily to weekly.

The likelihood that your child will achieve the near-average adult target height range increases with an earlier start to growth hormone therapy. If left untreated, PDGH can cause delayed puberty and small stature.

Because not all children respond well to growth hormone therapy, doctors will constantly examine each child's progress during treatment.



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