What is the role of growth hormone?
Why and how is growth hormone therapy performed in children?
Did you know that growth stimulants and anabolic agents are used in children and adults today?
Where does the treatment of children with growth hormone come from?
Before treating children with growth hormone, it is good to know a little about growth hormone and its treatment history.
What is Growth Hormone or GH for short?
Growth hormone is secreted from the front of the pituitary gland. The pituitary gland is a small gland in your brain and inside your skull that plays a very important role in controlling and coordinating growth processes, sexual maturity and human metabolic processes.
Growth hormone secretion from the pituitary gland is controlled by two other hormones.
One: growth hormone-releasing hormone secreted by the hypothalamus is called growth hormone-releasing hormone, or GHRH.
Two: somatotropin-inhibiting hormones (somatostatin) that are also secreted from the hypothalamus and affect the pituitary gland.
Throughout a normal human life, growth hormone is secreted, enters the bloodstream, travels to the liver, and undergoes changes there that make it ready to function.
Growth hormone alone, directly and without the above changes, can be effective in the processes that lead to growth and body building, which are generally called anabolic processes.
It is said that growth hormone in the liver is converted into a production factor called IGF, and in fact this compound causes the body to build and grow.
Also in cartilage itself, growth hormone can be converted to IGF and stimulate bone growth and regeneration of bone and cartilage completely locally.
History of short stature treatment with growth hormone
It is said that for the first time in 3 years, a person named Raben used growth hormone to treat achondroplasia due to pituitary insufficiency.
After all these years, although the total number of people treated with growth hormone in the world has increased, but its consumption is limited to severe cases of growth hormone deficiency.
In 1981, a child treated with human growth hormone, or HGH, develops a neurological disorder, and doctors and researchers find that there is a part of a virus (prion) inside the injected substance that is responsible for the disorder. The nervous system is the child, so man tried to make synthetic types of growth hormone.
In the same year, growth hormone was introduced biosynthetically and its use was expanded.
What will these growth hormones be used for in children?
We will answer the above question below:
Initially, if a child’s disorder was classified into any of the following groups, that child would be a good case for growth hormone therapy.
- Pituitary and hypothalamic problems that lead to decreased growth hormone:
- Hypothalamic defect and GHRH deficiency
- Pituitary cells’ resistance to GHRH
- Problems with the secretion of growth hormone by the pituitary gland
- Problems with the pituitary gland itself and decreased growth hormone production.
- Abnormal and inactive growth hormone
- Problem in the production of IGF by the liver
- Lack of response of body cells to IGF or in other words resistance to IGF
But these days, with the advancement of human knowledge, therapeutic uses of growth hormone have become very widespread.
Sometimes in some countries the drug is so expensive and scarce that a special protocol is specified to determine the essentials of growth hormone therapy.
In general, if growth hormone is used for treatment in children, most physicians pay attention to its results in the growth of the child, and if growth hormone is used for treatment in adults, its anabolic or manufacturing properties are used more.
What is growth hormone used for today?
Today, applications of growth hormone therapy include:
- A) Increased growth rate in people with:
- Growth hormone deficiency
- Turner syndrome
- Chronic renal failure
- Prader-willi syndrome
And to increase the growth and weight of the infant who has been underweight for a certain age of pregnancy
In the above cases, the positive and effective effect of growth hormone treatment has been identified and proven.
Growth hormone therapy may also be helpful in the following cases
Short stature without cause
Syndromes that lead to physical changes in children and are commonly known as dysmorphic syndromes
In children receiving chronic corticosteroids.
In the following cases, the effectiveness of growth hormone therapy is very unlikely:
- Skeletal dysplasia
- Achondroplasia in family
- B) The productivity of the anabolic effects of growth hormone in individuals is as follows:
- Growth hormone deficiency in adults
- Patients with secondary cachexia in AIDS
- People with weight gain cachexia
- (A cachexia in medicine is a condition in which a person loses body weight very clearly and severely)
In the above cases, growth hormone will probably be useful.
The use of growth hormone therapy in the following cases still needs further study:
- Very severe trauma
- People who undergo very serious surgeries
- People with chronic diseases
- People with osteoporosis
Growth hormone therapy has not yet been performed in premature infants and obese children.
In the following, we will briefly describe some uses of growth hormone therapy in children.
Treatment of children with Turner syndrome with growth hormone
Almost all Turner children are achondroplasia. These children are girls who have only one X chromosome.
Intrauterine growth failure, decreased growth in childhood, and lack of puberty or delayed puberty are seen in these children.
Without growth hormone, the final height of Turner women will be about twenty centimeters shorter than their peers.
These people do not necessarily have growth hormone deficiency, the main cause of this decreased growth in Turner girls is unknown.
Growth hormone treatment causes a significant increase in height growth in these children.
In addition to growth hormone in these children, doctors also use oxandrolone, which is an anabolic stimulant for growth and construction.
The time to start growth hormone therapy in children with Turner is about two to five years old.
The dose of growth hormone used in children with Turner should be 20% higher than in children who, for whatever reason, have only growth hormone deficiency.
Treatment is usually continued until a person is 15 years old or when their annual height is less than two centimeters.
The following are effective in responding to treatment:
- Age of onset of growth hormone therapy
- Duration of treatment
- Dosage of growth hormone and applied estrogen
Generally, five to sixteen centimeters of height increase with these treatments is observed in Turner children.
Chronic renal failure in children and growth hormone therapy
Children with chronic kidney failure are very likely to have growth retardation.
With the prescription of growth hormone, about four to eight centimeters of longitudinal increase in height is observed during the first year of treatment.
Standard treatment does not severely accelerate bone growth, nor does growth hormone treatment cause electrolyte disturbances. About forty-five percent of children with chronic kidney failure who have developed growth hormone will reach normal height in their sex and race.
Dialysis children will respond less to the above treatment. With a successful transplant, the kidney response will be greatly improved.
small for gestational age
These babies are more likely to be shorter than their peers in the future.
Fifteen percent of these children grow slowly and will be short.
The cause of this problem is still unknown.
Fifty to sixty percent of these children have a marked reduction in growth hormone secretion for three to ten years, according to a study.
The following are effective results in the final treatment with growth hormone:
Child age (lower age equals higher performance)
Dose of growth hormone used in treatment
Height status of family and parents of the child
In addition to being short, these children may reach puberty earlier than their peers.
Children with Prader-wille syndrome and growth hormone therapy
According to doctors, the most common genetic cause of this syndrome is obesity.
In affected children, a defect on chromosome 15 inherited from the PWS paternal gene which causes Prader-wille syndrome
These children will have the following signs and symptoms:
- Muscle relaxation or hypotony
- Hypogonadism or defects in the gonads
- Delay in evolution
- Short height
The benefits and harms of growth hormone in these children should be considered and then the correct treatment decision made.
Children with dysmorphic syndromes and growth hormone therapy
The following syndromes are usually associated with short stature:
- Down syndrome
- Noonan syndrome (defect in chromosome 12)
- Russell Silver Syndrome
- Aarskog syndrome
In the above four syndromes, an increase in height growth has been reported after treatment with growth hormone.
Growth hormone therapy in children taking steroids
Children with Cushing’s syndrome or long-term users of corticosteroids become short.
Steroids may reduce minerals and inhibit bone formation.
Steroids also cause a decrease in growth hormone receptors.
Children in this group who have been treated with growth hormone for one to two years have reached normal height.
Skeletal dysplasia in children and growth hormone therapy
Children with achondroplasia may grow taller by receiving growth hormone.
At present, doctors say that although in cases of skeletal dysplasia, growth hormone may be seen in the first year of treatment with growth hormone, growth hormone cannot have a definite and long-term effect on the final height of individuals.
Growth hormone therapy in children with cystic fibrosis
There is a reduction in hospitalization, improvement of pulmonary function, and an increase in height in these children, but in these children there is a high risk of developing diabetes, so treatment decisions must be made carefully.
The side effects of growth hormone therapy are as follows:
- In children, treatment with standard doses of growth hormone is safe.
- No malignancy or cancer have been reported.
- There has been a benign increase in intracranial pressure in a number of children.
- Weight gain unrelated to fluid retention.
- Benign dark spots.
- In some inflammation of the pancreas or pancreatitis.
There is a risk of glucose intolerance and diabetes, but the actual risk has been small.
There are reports from Japan that the risk of leukemia in children treated with growth hormone is twice as high as in other children, but more extensive global studies deny this.
Until about ten years ago, there were about one million children treated with growth hormone, among whom there has never been a case of cancer outbreak compared to the general population.