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Brief and Straightforward Guide on: HGH Deficiency

What is Growth Hormone Deficiency?

Growth Hormone Deficiency (GHD) is a medical condition in which, the adenohypophysis or the anterior part of the pituitary gland fails to produce sufficient amounts of the Growth Hormone that is essential for normal bone and muscle growth.

The Growth Hormone is crucial for the normal growth and development in children and adolescents. In adults, the Growth Hormone plays a critical role in the maintenance of muscle tone and muscle mass, calcium preservation, bone mineralization, protein production, pepping up the immune mechanisms of the body, staving off premature ageing and preserving youthfulness. It plays a key role in cell reproduction and thereby stimulates the growth of various body tissues.

Growth Hormone deficiency can occur at any age. The hormone deficiency has different effects at different ages. Clinical manifestations vary with age, i.e. the symptoms would be different in the new born, during infancy, during childhood, adolescence, and adulthood.

What are the causes for growth hormone deficiency?

Growth hormone deficiency is caused due to reduced or absent secretion of the Growth Hormone from the anterior Pituitary gland.

The causes could be:
Congenital, i.e. present since birth. Congenital Growth Hormone deficiency may be associated with an abnormal or malformed pituitary gland. Congenital diseases such as Prader-Willi syndrome and Turner syndrome result in GHD. GHD may be an isolated deficiency or may occur in association with other Pituitary hormones deficiencies.
Damage to the Pituitary from radiation therapy to the head, for leukemia or brain tumors, from surgery, from trauma, or from intracranial diseases are other significant causes.
Acquired i.e. the disorder occurs later on in life. Acquired causes of GHD include infections, brain tumors, trauma / injury, surgery, or radiation.
Gene mutations are other possible causes for GH deficiency.
Idiopathic, i.e. the cause is not known

It is important to differentiate a deficiency disorder from the process of natural ageing. In normal ageing, there is a reduction in the amount of Growth Hormone released every day and also, in the pattern of secretion.

What are the symptoms of Growth Hormone Deficiency?

Symptoms of GH deficiency in children are:

A short stature
Low growth rate for the age and pubertal stage
Onset of puberty is delayed
Mild to moderate chubbiness with excessive amount of fat about the waist
The child looks smaller / younger than other children of his age
Slower muscular development and delay in the development of gross motor milestones - standing, walking, running, and jumping.
Delay in the development of teeth
There could occur hypoglycemic attacks
Repeated bouts of jaundice
Some children may also have episodic seizures

Symptoms of GH deficiency in adults are:

Reduced levels of energy, weariness and exhaustion
Lowered strength and exercise endurance
Reduced muscle mass
Reduced bone density, reduced bone mass, and osteoporosis
Obesity and weight gain, especially around the waist
Lipid abnormalities, predominantly increased levels of LDL cholesterol
Anxiety, gloominess, poor concentration and loss of memory

When should you seek medical care?

If the individual manifests any of the symptoms or clinical manifestations of the deficiency syndrome, it is advisable to consult a pediatrician or endocrinologist.

Diagnosing Growth Hormone Deficiency

The diagnosis is made by pediatric endocrinologists (for children) and internist endocrinologists (for adults).
To establish whether GHD is present, a Growth Hormone stimulation test is performed.
For the investigation, Insulin (An Insulin Tolerance Test is age-independent, reproducible, and is able to differentiate between GHD and normal adults, and therefore, is the test of choice) is administered through an IV, to create a low plasma sugar level. The peak Growth Hormone level is then measured about 20 to 30 minutes later.
If the peak Growth Hormone level is less than 10 mcg/mL in children, or less than 3 mcg/mL in adults, Growth Hormone Deficiency is diagnosed.
Individuals who have GHD may demonstrate increased total cholesterol level, raised low density lipoprotein cholesterol (LDL or bad cholesterol), raised apo-lipoprotein B, and heightened levels of serum triglycerides.
Other investigations like - CT scan and/or MRI of the brain and/or bones may also be done to assess the presence of tumors.
Reduced bone density can be evaluated by a bone density scan.
In children, the physician will observe the child's growth and development over a period of time, in order to ascertain whether the growth rate is abnormal. He may look in to the mother's pregnancy, labor, and delivery to ascertain likely causative factors.
Occasionally, the doctor may keep the patient overnight, to screen the levels of GH secretion.
Clinical examinations along with symptom-manifestations help make the correct diagnosis.

Therapeutic management of GH deficiency

The goal of treatment is to increase growth and development in children, and reinstate energy, metabolism, and body composition in adults.

The doctor prescribes HGH or Somatropin (bio-synthetic hormone). The drug is given as intra-muscular injections.

Children receive daily injections of the Growth Hormone. The pediatric endocrinologists supervise the growth and regulate the dose every 36 months. Treatment is by and large extended as long as the child is growing, and lifelong continuation may be advocated for severe deficiency cases.

Adults are given weekly doses, around 25% of that given to children.

Prognosis or the outcome of the HGH therapy

In children, HGH therapy enhances the growth rate and promotes the development of muscle.

When treated with the synthetic GH, a severely deficient child will begin to grow fast. In the first year of therapy, the rate of growth may increase to twice as fast as other children are growing. Growth slows in the following years, but remains above normal, so that, the child who had fallen far behind in his height, may grow to achieve the normal height range.

In adults, the treatment promises to build muscle, increase muscle mass, augment strength and endurance, improve bone density, boost energy levels, reduce body fat by revving up the metabolism, lower cholesterol levels, and promote mood stability.