Growth hormone deficiency is only one of the reasons for short stature in children, which is why a comprehensive and accurate medical evaluation is necessary before starting treatment. How is it diagnosed, who is eligible to receive the treatment, what are the side effects, and what innovations have entered the field?
For many parents, their children's height is a source of considerable concern. When a child is significantly shorter than their classmates or looks as if their growth has stopped, the first question that arises is whether it is family genetics or a medical problem that can be treated.
One of the most well–known options is growth hormone deficiency, but experts emphasize that this is only one of many reasons for short stature in children. In fact, most short children do not suffer from a lack of growth hormone at all.
So when should you turn for an evaluation, how is the problem diagnosed, who is the treatment intended for, and what is important to know before starting?
What is growth hormone and why is it important?
Growth hormone is produced in the pituitary gland at the base of the brain and plays a central role in a child's development. It stimulates the production of the growth factor IGF1, which acts on the growth plates at the ends of the bones and allows them to lengthen.
Beyond its effect on height, growth hormone also plays a role in building muscle mass, regulating metabolism, and maintaining the proper ratio between fat tissue and muscle tissue.
Not every short child suffers from growth hormone deficiency
The most common reason for short stature is actually genetics. Children of short parents will usually be shorter than their peers, even when they are completely healthy.
There is also a common phenomenon known as "constitutional delay of growth and adolescence." These children grow at a slower rate during childhood, but later close the gap and reach a normal height in adulthood.
In addition, there are chronic diseases, nutritional disorders, genetic syndromes, thyroid disorders, and other medical conditions that can affect growth.
When should a problem be suspected?
Pediatricians recommend regularly tracking growth charts. Signs that could justify an evaluation include:
• Height that is below the 3rd percentile
• A decrease in growth percentiles over time
• A significant slowdown in the rate of growth
• A notable delay in sexual maturity
• A significant gap between the child's height and the expected height based on their parents' height
Sometimes a growth disorder is the first and only sign of a hidden medical problem.
How is growth hormone deficiency diagnosed?
Contrary to what many think, it is impossible to diagnose a growth hormone deficiency using a regular blood test. The reason is that the hormone is secreted in pulses throughout the day and night. Therefore, even a completely healthy child may show very low values in a random test.
For the purpose of diagnosis, special stimulation tests are performed, in which substances that encourage the secretion of growth hormone are given. Afterwards, hormone levels are tested at several points in time.
Only when two different stimulation tests indicate a deficiency can it be determined that there is indeed a growth hormone deficiency. In such cases, a brain MRI is usually also performed to check the integrity of the pituitary gland.
Who the treatment is suitable for and how it is given
Growth hormone treatment is currently given in several defined medical conditions:
• Proven growth hormone deficiency
• Children born small for gestational age who did not close the growth gap
• Turner syndrome
• Prader–Willi syndrome
• Noonan syndrome
• Chronic renal failure
• In certain cases of extreme short stature without a clear cause
The decision to start treatment is made after a comprehensive endocrine evaluation and in accordance with clear medical criteria.
Modern growth hormone is produced by genetic engineering and is almost identical to the natural hormone. Until recently, the treatment was given via a daily subcutaneous injection, usually in the evening hours before bedtime, to mimic the body's natural secretion pattern.
In recent years, innovative preparations given once a week have also come into use, at least for some of the medical indications. Studies have shown that their effectiveness is similar to that of daily injections.
When do you see results – and how many cm will the child grow?
The good news is that in most cases, the response to treatment is relatively fast. In the first and second year, a significant acceleration in the growth rate can be seen, sometimes twice or even four times the rate before the start of treatment. The best response is observed in younger children, in children with a significant growth hormone deficiency, and in those who start treatment relatively early.
This is perhaps the question that parents ask more than any other. The answer varies greatly depending on the reason for the treatment. In children with a significant growth hormone deficiency, it is sometimes possible to gain about 10 to about 20 centimeters in final height.
On the other hand, in other situations, the average addition to the final height usually stands at about 4 to about 5 centimeters.
Are there side effects?
The treatment is considered very safe and has been in use for decades. However, like any medical treatment, it also has possible side effects, although they are relatively rare. Among the symptoms that may appear:
• Headaches
• Dizziness
• Visual disturbances
• Edema
• Leg pain
• Irritation in the injection area
• Increased intracranial pressure in very rare cases
Therefore, any child receiving growth hormone is under regular supervision by a pediatric endocrinologist.
Growth hormone is one of the most significant treatments in modern pediatrics, but it is not intended for every short child.
The most important message for parents is not to rely only on the child's current height, but to track the rate of growth over time. When a suspicion of a slowdown in growth arises, it is important to turn for an orderly medical evaluation.
In appropriate cases, early diagnosis and correct treatment can significantly improve the rate of growth, the final height, and sometimes also the child's self–confidence and quality of life.