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Brief and Straightforward Guide on: Growth Hormone Deficiency In Children

Understanding Growth Hormone Deficiency

The deficiency of the Growth Hormone is a clinical disorder, which involves a small gland located in the skull base, referred to as the pituitary gland. The pituitary gland secretes a host of essential hormones for the body, including the growth hormone. The Growth hormone controls various essential functions like - cell reproduction and organ growth. When the pituitary fails to produce adequate quantities of the growth hormone, it tends to retard growth and development in children.

The growth pattern assessment of the child in an integral part of determining normal growth. On an average, a child’s height increases by about two inches each year. This normal pattern growth is altered in children having growth hormone deficiency. In most cases, the deviation from the normal growth pattern is observed only after the age of three years. Also, a child suffering from growth hormone deficiency will look relatively younger than his/her age. Occasionally, disproportionate body structure (i.e. size of one part of the body in relation to another) may also be observed.

Causes of Growth Hormone Deficiency in Children

There are several reasons which contribute to GH deficiency in children.

• Congenital GH deficiency: When the Growth Hormone deficiency is present since birth, it is referred to as a congenital disorder. The underlying pathology could be related to an abnormal development of the pituitary gland or could be a part of another syndrome.
• Acquired GH deficiency: When the deficiency of the growth hormone is not present since birth, but occurs at any time during childhood, it is referred to as acquired GH deficiency. The causes for acquired GH deficiency include - trauma to the base of the skull damaging the pituitary gland, infection or exposure to radiations during the growth phase. Cranial infections have also been found to be associated with GH deficiency.

Further, some children may suffer from “apparent” Growth hormone deficiency. In this condition, the pituitary secretes normal levels of HGH, however, the body fails to respond to the circulating HGH in the blood. This condition is genetic and runs in families, but occasionally, some children tend to develop this condition without any family history or any specific cause. This is referred to as ‘iatrogenic’ growth hormone deficiency. Premature babies with a small gestational age have a higher risk of developing growth hormone deficiency, compared to children born at normal gestational age.

Symptoms of Growth Hormone Deficiency in Children

The clinical manifestation of GH deficiency in children has a unique presentation which comprises of the following signs,

• Short height for age. Since, the height is determined by the genetic constitution and certain environmental considerations, there is a possibility that the short stature may not exclusively be attributed to GH deficiency
• Increased deposition of adipose tissue (fat) around the waist and the face. The child may appear younger than his/her age. In cases of severe Growth Hormone deficiency, characteristic facial features may develop which include - prominence of the forehead and hypoplasia of the maxillary region. Some children may also present with sparse hair growth and frontal recession.
• In most of the children, the onset of puberty is considerably delayed, and males present with smaller penis size. Furthermore, gross motor milestones like: walking, standing, jumping, running, etc are considerably delayed along with delay in tooth development.
• Mental anxiety and apprehension about the height and excessive weight gain.

Seeking medical advice

It is essential to approach a pediatrician or an endocrinologist when there are concerns over the child’s growth, especially height. The child’s growth patterns (height and weight) are plotted on a graph, so as to compare it with standards for the respective age. This helps the physician to assess any unusual growth patterns and problems in the development. At this juncture, it is crucial to understand that all deviations from normal growth pattern do not indicate HGH deficiency in children. There are several other causes for deviation from normal growth pattern, which may include - environmental causes (malnutrition and faulty diet) or genetic factors (i.e. short stature parents). In such cases, dietary corrections can help improve the height and control the weight of the child.

Assessment of the Clinical Condition

• A detailed evaluation of the medical history and medical condition is a pre-requisite. Information about growth pattern of the child’s parents may also be essential for the diagnosis.
• After a detailed medical history, the physician would assess the child’s height and weight by plotting them on a growth chart. This allows easy comparison of the growth with normal growth standards.
• Various tests would be performed to pin point the actual cause of the growth delay. These tests include: Thyroid function test to eliminate hypothyroidism as a cause of delay in growth, assessment of the electrolyte levels to verify the kidney functions, complete blood assessment and count, Insulin Like Growth Factor (IGF-1) test, Radiological investigation like X rays or MRI scan to check the bone size in the child, etc. Karyotyping (i.e. a study to evaluate a person’s chromosome profile) may be performed in some children where conditions like Turner’s syndrome are suspected.

Treatment Options

There are limited treatment options when it comes to the management of Growth Hormone Deficiency in children. These include:

• Human Growth Hormone Replacement Therapy: HGH replacement therapy involves recombinant GH shots underneath the skin, on daily basis. This is aimed at supplementing the need for the growth hormone in the children, through an external source
• Surgery: Surgical intervention is not an option for management of Growth hormone deficiency per say, but is considered in cases where there is a tumor or a deformity which is interfering with the normal functioning of the pituitary gland.

Prognosis

Early diagnosis and treatment is crucial in the successful management of HGH deficiency in children. With GH replacement therapy, the child grows by about 8-10 centimeters annually. However, the growth tends to slow down as the age progresses. In most cases, for effective management, the therapy needs to continue into adolescence, to improve the chances of the child attaining a normal adult height.

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