FAQ Part II

Growth Hormone therapy for both children and adults... is often confusing. To help you we have put together a list of questions which we are often asked by parents. Remember these are questions specific to children who are either newly diagnosed or just starting growth hormone treatments. If you don't see an answer to your question, or just need to talk with a more "experienced" parent who has gone through this- Please call! That is why we are here. We have faced this and know how challenging it can be!

PART II

1. My 2 yr old son is 36 1/4" and 64 lbs. He has been recently diagnosed with Growth Hormone Deficiency. Our Endocrinologist recommends we give him growth hormone injections. We are not sure, however, if this is going to make him even taller than he already is. Also, can we expect him to stop gaining weight so rapidly if he does take GH?
   
   I accept that your endocrinologist has properly diagnosed GH deficiency in your son. Since he is at the 90th percentile for height and way over the 95th percentile for weight (weight age 9 9/12 and BMI 34) there must be more to the story of why he was evaluated in the first place. Did he have a tumor of the pituitary? Certainly, GH would be given to allow him to grow taller as he grows older. If anything, having an adequate level of growth hormone would tend to favor muscle over fat formation and to redistribute the fat so there is less visceral and abdominal fat. On the other hand, giving GH to treat obesity in a child who is not GH deficient is not an accepted indication and probably would prove to be of little or no benefit anyway.
   
   
2. Is growth hormone used to help children that are bigger than they should be for their age?
   
   The question is, on the surface, counterintuitive since Growth Hormone is given to make children grow. However, there could be a child growing above the 95th percentile who has a pituitary tumor or some other condition whose treatment renders him or her hypopituitary, or at least growth hormone deficient. This child would be eligible for growth hormone replacement to assure normal future growth. There is no reason to allow the child to go untreated and to progressively fall into lower percentiles, or below the 5th percentile, in order to initiate growth hormone replacement. If there is an individual that the respondent has in mind, he or she should give more details on that child and I'll try to address that situation specifically.
   
   
3. Our son Shane (2 years 5 months) diagnosed with Congenital PHP (Diabetes Insipidus, Hypothyroidism, Cortisol deficiency and GH Defiency). Shane is tall for his age but is not of GH as he does not fit the New Zealand criteria due to his height. However, he is not walking and his speech is delayed (babbles, but only says a few words and does not join any words together). Could this be due to GH deficiency i.e. low muscle tone?
   
   GH is necessary for muscle mass and strength but the developmental aspects sound more neurological in origin. He should be on GH despite his height and have a full developmental evaluation.
   
   
4. My daughter is 48" in tall and weighs 62 lbs. She is 10 1/2 years old and is the shortest kid in her class. My husband is 5'11 and I am 5'1. Is she Growth Hormone Deficient? Height is affecting her emotionally. She is withdrawn and shy but a good student (often lonely). Are these signs of GH deficiency? Please help.
   
   I can't say that she is GH deficient but I can say that she should be evaluated for that or other causes of short stature. Nothing improves the distress a child feels when small than growing.
   
   
5. My 11 year old son is currently on Protropin and has been for the past 2 years. I have heard rumors that the drug Protropin will be phased out in the near future. Is this true? If so, is there a timeframe in which this will occur? What is the difference between Protropin and Nutropin? I have heard that patients who switch from Protropin to Nutropin experience a burning sensation when the drug is injected. What causes this and does this sensation cease after a period of use? Thanks.
   
   Protropin is being phased out this year, although for those finishing in the near future it will still be made available. Nutropin has the same amino acid sequence as natural GH without the extra methionine (amino acid) attached to Protropin as part of the earlier manufacturing process. The extra methionine does not affect activity. Stinging may be caused by the preservative in the premixed AQ product. Nutropin "plain" is mixed just like Protropin and is not associated with any stinging. Only some patients feel stinging, and it may resolve on its own, but don't count on it.
   
   
6. Hi, I take Genotropin and whenever I inject it I get a small cyst like bump, why does it do that?
   
   Are you injecting in the skin (skin popping) rather than the subcutaneous (fat)?
   
   
7. My daughter is 2 years 4 months old. She's growing so slowly that I took her to the hospital 4 months ago. She went through a lot of tests; X-ray, MRI, Insulin Tolerance tests and chromosome test. Results showed her pituitary had some structural problem by unknown congenital causes. The doctor said her pituitary gland was very small and the pituitary stalk rarely could be seen. Her bone age was 9 months at 24 months of chronological age. Her Growth Hormone secretion is at an extremely low level. She is far below the 3rd percentile on the growth chart in Korea. Her Thyroid Hormon level is not good either but it is just below the border line. Fortunately Turners Syndrome was ruled out. Her mental development and motor skills are pretty normal. Now she is taking Thyroid Hormon pills every day. But I've not yet decided when to start the HGH treatment. GHDs under 5 years old can't get the financial support from Health Insurance Funds in Korea. Should I put my daughter to the HGH treatment immediately in spite of financial difficulties? Or doesn't it make any big difference if I wait for 2 or 3 years until she becomes eligible for getting insurance help? Some experts are saying the sooner the better. On the other hand, I've read some stories of GHD families on the internet saying they've started the treatment at age 5 or 6 and their children are about to reach their full height potentials. What is the final height difference in general between starting HGH treatment at the age of 3 years old and at the age of 5 years old? Thanks for your kind advice.
   
   It is better for the child's growth if she were started immediately, but I fear that the cost is so great that you will have to wait until it can be paid for. The ultimate height may be slightly less, but still can be normalized even with the delay.
   
   
8. I am 5.02" my husband 5.04" my sister 5.0" my sister inlaw 5.0" etc. There is some history in my family of both sides of short stature. I remember being short all my life. I was 3rd shortest of my generation as I went into puberty at 13. I began to grow when I was 17 and I am growing as of today. My daughter just turned 7 years old and she is 41.5 inches. If this is only genetics, do you treat it the same, as the children with any other disorder like GHD, or maybe she could have a Constitutional Delay Problem?
   
   This doesn't sound at all like only Constitutional Delay since you all wouldn't end up so short. There may indeed be a genetic component, perhaps leading to GH deficiency. Your daughter should have such testing.
   
   
9. My son who is 7 years old was born with Spina Bifida and has a shunt. He has just been diagnosed with GHD. Is there any correlation between the two conditions? Is it advisable to go ahead with GH therapy? Is there any increased risk of shunt or spinal cord complications from GH therapy?
   
   There may be a relation between spina bifida or the more severe meningomyelocele and short stature, with or without GHD. Treatment with GH should proceed but a major concern is whether there is a tethered cord which may require surgical release.
   
   
10. My child just completed the stim test after initial growth hormone readings were "deficient". His bone age was also "advanced". I understand that he has less time to grow. How significant is it to be deficient with an advanced bone age?
    
    Very! If the bone age is too advanced, the predicted height is significantly decreased. In some patients, medications such as Lupron may be used to try to slow further advancement of the bone age and allow more time to grow.
    
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