Growth hormone deficiency

Reviewed by Dr Stephen Greene, consultant paediatrician

What is growth hormone deficiency?

Growth hormone deficiency can be both a total or a partial condition, resulting in impaired physical development.

The growth hormone is one of the hormones produced in the pituitary gland (hypophysis), a small gland situated on the underside of the brain.

Secretion of the growth hormone is controlled by other hormones released by a different part of the brain. When the growth hormone enters the bloodstream it stimulates the liver to secrete yet another hormone, 'insulin-like growth factor' (primarily IGF-1).

The elderly naturally produce less growth hormones than young adults.

What causes a growth hormone deficiency?

There are several possible mechanisms that result in a growth hormone deficiency:

insufficient release of stimulatory hormone from the hypothalamus.

insufficient production of growth hormone by the pituitary.

decrease in IGF-1 hormones.

problems can also be caused by defects in the receptors that 'receive' the hormone in the body's cells.

There are many possible causes for a growth hormone deficiency including:

very rarely it may be due to a genetic defect, which in some instances may also be hereditary.

a lack of oxygen at birth.

diseases in the pituitary gland, the brain or the liver.

abnormalities in the hormone receptors.

an autoimmune attack.

however, more often than not, there is no single, clear explanation.

If the pituitary gland function is abnormal, the production of several other types of pituitary hormone may also be reduced, leading to other conditions.

What are the symptoms of growth hormone deficiency?

A total growth hormone deficiency is often discovered in a child's infancy. At birth, the infant's height and weight are normal. However, between three to nine months the child's growth rate will be reduced (growth disturbance). Later, the ability to gain weight begins to diminish; teeth development is delayed and the child may also acquire a thick layer of fat under the skin. This symptom will not always be visible if the growth hormone deficiency is only partial.

What can I do?

Everybody can measure and weigh their children. However, health visitors and doctors should regularly carry out a growth examination that follows specific guidelines, since measurements completed at home may be inaccurate and the interpretation of 'growth curves' - tables used to measure growth accurately - can also be difficult.

If the child's growth seems to be causing problems, consult your GP.

How is a growth disturbance diagnosed?

The doctor measures and weighs the child and draws growth curves. The parents' height and weight as adults, at puberty and as infants will be taken into consideration.

The doctor will also ask questions about the child's diet, appetite, exercise habits, pattern of defecation and any social problems.

The child is then examined for signs of disease, and, possibly, puberty and tooth development.

In addition, an X-ray of the left hand and wrist may be taken to examine bone development. The so-called 'bone age' may be small in relation to the child's age.

If the doctor suspects a growth hormone deficiency, a consultation at a specialist paediatric unit may be advised. In the paediatric unit, the IGF-1 is measured and further blood tests are taken to test for other possible diseases. A growth hormone-stimulation test will be administered: usually, it takes two of these tests to properly diagnose a growth hormone deficiency.

What are the future prospects?

The child's growth will be severely impaired if a growth hormone deficiency is not treated. The child's potential to gain height depends on the degree of the condition. If the lack of hormone is treated in its early phase, it is likely that the child will gain several extra centimetres bringing the child into the normal range for height.

How is growth hormone deficiency treated?

Treatment, available at special paediatric units, is by means of a synthetic growth hormone injected each day until the child stops growing. The parents are trained to administer the injection. The correct amount of growth hormone has to be determined exactly, and the child needs to be closely monitored and examined for possible side effects, even though side effects are very rare. When this treatment has been completed, a reassessment is necessary to see if the child is likely to respond to further treatment in adulthood.

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