Hormones are chemical substances that affect the activity of various cells and tissues in the body. Growth hormone affects the growth and development of the body and is produced in the pituitary gland, a gland located at the base of the brain.
Table of Contents
- Growth hormone deficiency is quite common and is characterized by general developmental and height growth retardation.
- The symptoms of growth hormone deficiency depend on the age at which the deficiency develops and the cause.
- In most cases, the cause of growth hormone deficiency cannot be identified, although sometimes the cause is a congenital abnormality or a brain tumor.
- Diagnosis of growth retardation in a child is based on physical examination, growth chart/graph data, as well as the results of radiological, laboratory, and genetic studies.
- Treatment usually includes hormone replacement therapy.
Children with growth hormone deficiency may also have deficiencies of other pituitary hormones: thyroid-stimulating hormone (TSH), adrenocorticotropic hormone (ACTH), follicle-stimulating hormone (FSH), and luteinizing hormone (LH). This condition is called hypopituitarism.
In addition to growth hormone deficiency, short height can also be caused by other reasons. For example, most children and adolescents with short height are short because their family members are also short, or because their growth spurt occurred late in the normal developmental timeline.
Some children are short because they have inadequate weight gain and inadequate nutrition, or because they have certain chronic diseases that affect the thyroid, heart, lungs, kidneys, or intestines.
Also, short height in some children is associated with genetic disorders that affect bone growth, such as Turner syndrome or skeletal dysplasia.
The cause of growth hormone deficiency, in the absence of other hormonal disorders, is often unknown. However, in about 25% of cases, a specific cause can be identified, including:
- Defects in specific genes
- Brain abnormalities, tumors, or injuries
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Symptoms of growth hormone deficiency
The symptoms of growth hormone deficiency depend on the child's age and the underlying cause.
Children have a low overall growth rate. They usually grow:
- Up to 4 years old per year 2.5 inches (about 6 cm) With less,
- 4–8 years old per year 2 inches (about 5 cm) With less,
- Before puberty per year 1.5 inches (about 4 cm) With less.
Most children have short stature, although the proportions of the upper and lower body are normal. Some children may also have delayed tooth development.
A wide range of disorders develop depending on the causes of growth hormone deficiency.
Newborns who have growth hormone deficiency may experience:
- Low blood sugar (Hypoglycemia),
- Jaundice (Hyperbilirubinemia),
- Other congenital abnormalities, such as small genitalia in boys (Micropenis) or facial defects (for example, cleft palate).
Puberty may be delayed. Sometimes there is a violation of the proportionality of weight gain with height. This ultimately becomes the cause of the development of obesity.
Sometimes there are also signs of deficiency of other pituitary hormones.
Diagnosis of growth hormone deficiency
Diagnosis begins with a pediatrician's assessment of the child's physical data, which is considered along with medical history and family history. Instrumental and laboratory tests are also performed:
- X-ray
- Blood laboratory tests
- Genetic studies
- Imaging studies (MRI)
- Stimulation tests
It is impossible to draw conclusions about why a child is stunted based solely on growth hormone levels. The indicators must be considered in correlation with other studies.
First, the doctor measures the child's height and weight and uses age-specific charts to determine how slow the growth process is.
An X-ray examination of the bones of the hand (“bone age” X-ray) is often necessary to assess whether bone development is appropriate for age.
Sometimes bone development is age-appropriate and the child is simply short.
In children with growth hormone deficiency, bone development is also delayed. Delayed bone development is associated with hypothyroidism and delayed puberty (the period of sexual maturation).
Direct determination of growth hormone often gives an inadequate answer, because its level fluctuates. To determine the exact level of growth hormone, the parameters that are directly affected by growth hormone are determined: for example, insulin-like growth factor 1 (IGF-1) and insulin-like growth factor-binding protein 3 (IGFBP-3).
However, these parameters can be affected by other conditions, such as hypothyroidism, celiac disease, and malnutrition. Therefore, studies are also organized to exclude these pathologies.
If laboratory data indicate possible damage to the pituitary gland, it is necessary to perform an imaging study (MRI) to detect structural pathology of the gland.
If laboratory tests show low growth hormone levels and there are no other causes, it is necessary to perform a stimulation test - that is, medical stimulation of growth hormone secretion, after which hormone levels are determined every few hours.
Symptoms of growth hormone deficiency in children
Growth hormone deficiency occurs in 1 in 4000 children. The main characteristic is short height compared to children of the same age and sex.
- Hypoglycemia in children
- Delayed development of genitals at birth
- Delayed puberty in adolescents
- Vision impairment in some adolescents
- Childlike features of the face and torso
Children with congenital growth hormone deficiency may have normal or slightly reduced height at birth.
Hypoglycemia (low blood sugar) Often an early and important clinical sign of growth hormone deficiency.
Height loss It may only become apparent later, when the child's growth no longer matches the development of their peers.
Symptoms of growth hormone deficiency in adults
Growth hormone deficiency detected in childhood usually persists into adulthood and is accompanied by various health problems:
- Fat accumulation in the abdominal area
- Decreased muscle size and overall strength
- Decreased sweating and impaired body temperature regulation
- Decreased sensitivity of cells to insulin (insulin resistance)
- Reduction in heart muscle mass
- Decreased ability to perform physical activity
- High LDL and low HDL levels
- Decreased bone mineralization and increased risk of fractures
- Drowsiness
- Weakness
- Mental and psychological complications
- Depressed mood
- Decreased concentration
- Anxiety
- Low self-esteem
- Frequent illness
- Social isolation
- Deterioration in quality of life
Diagnosis of growth hormone deficiency
The tests begin with a personal and family history and physical examination, based on which the doctor determines a test plan:
- "Bone age" radiography
- Identification of insulin-like growth factors and their binding protein
- Growth hormone stimulation test
- Magnetic resonance imaging of the brain
Treatment of growth hormone deficiency
The most common treatment for growth hormone deficiency is synthetic hormone replacement therapy. Hormone replacement therapy:
- Improves the growth process
- Improves body composition and bone mineralization
- Reduces the risk of cardiovascular diseases
- Improves quality of life
If other causes of growth retardation are discovered, appropriate treatment is necessary.
https://my.clevelandclinic.org/health/articles/21559-child-development
