Norditropin Mexico - Growth
Let’s talk about growth
If your child’s doctor have noticed a slowdown in his or her growth rate, you may be wondering if you should be concerned.
Here we’ll talk about that and more of your growth questions, to help you determine what the next steps might be for your child, and what to expect at each step.
Is my child growing normally?
Everyone is different, so it is impossible to define “normal” for any one individual. You may notice your child is not growing as you might have expected. Or, by tracking growth on a growth chart, your doctor may detect a slowdown in your child’s growth rate. Together, you and your health care provider can determine what normal growth might look like for your child.
Generally speaking, most children grow about 4 inches per year between ages 1 and 4, and about 2–2.75 inches per year from ages 4–8.
To put it another way, a child who is growing normally will generally reach certain milestones over the months and years:
A few basics about growth
Why is growth important?
A child’s growth is much more than just how tall he or she is, or how tall they are compared to their friends. Growth can be an important indicator of overall health and physical development. If your child is not growing as he or she should be, it can signal a possible medical condition.
How can I tell if my child is growing enough?
Make sure that your child is measured at least once per year, and that you understand his or her percentile. Make a note about whether it’s changed since previous measurements. If you have concerns about your child’s growth, talk to their doctor.
How do children grow?
Growth has two main components: genes and hormones. Height is mostly determined by genes, which is why a person’s adult height tends to fall within the range of other family members’. Hormones, which are chemical messengers produced in the glands, send signals throughout the body, telling it to perform certain tasks—like “grow.”
What is growth deficiency?
“Deficiency” simply means a shortage, or not enough. So, the general term “growth deficiency” refers to lack of growth. In some cases, lack of growth is not related to your child’s health. For other children, the cause may be a disease, genetic syndrome, or growth hormone deficiency.
When should I take action?
The bottom line is, if there are any issues with your child’s growth, talk to your doctor. A prompt referral to a specialist may offer the best chance for the appropriate diagnosis and treatment. That’s why it’s important to find out as soon as possible. The sooner your doctor knows what’s happening, the sooner you can start working on it—together.
What should parents know about growth hormone?
While slower growth can be caused by a number of problems (such as emotional stress, poor nutrition, or disease), it may be that the child’s body is not making enough growth hormone.
As the name suggests, growth hormone is the hormone responsible for making a child grow. It is produced by the body in the pituitary gland, which is located at the base of the brain, just behind the nose in the center of the head.
From about 6 months of age and throughout childhood, growth hormone is a critical factor in a child’s growth.
If, after examining your child, a pediatric endocrinologist determines your child’s growth patterns are unusual, he or she may choose Norditropin® to help your child grow and develop.
Types of Growth Disorders
Some children experience slow growth due to factors such as diet, emotional stress, or disease. For a small number of children and adults, their short stature is caused by a medical condition that either slows or stops growth. Norditropin® is used to treat some of these conditions.
Childhood Growth Hormone Deficiency
What is childhood growth hormone deficiency?
Growth hormone deficiency (GHD) means that your child’s body does not make enough growth hormone, which is needed for growth during childhood. Not enough growth hormone can cause poor growth in children.
What causes GHD?
Reasons for growth hormone deficiency include:
Lack of glandular development.
Children can be born with growth hormone deficiency because their pituitary gland or hypothalamus gland is not fully developed.
Glandular trauma or impediment.
Some children develop growth hormone deficiency after birth as a result of head trauma, a serious brain infection, or even a brain tumor.
What are the signs of GHD?
Most children with GHD appear otherwise healthy. Often, short stature is the only feature present. If GHD is the cause of your child’s slow growth, there are medicines that may help.
Children with GHD are shorter than other children who are the same age. They may have a growth curve that is often below the 3rd percentile, or are showing abnormally slow growth for a long period of time.
Some signs of GHD are:
Much shorter height than expected, based on biological parents’ heights.
Slowing of growth rate.
Growth that is below the 3rd percentile.
How is GHD diagnosed?
Your child’s doctor may check for other causes of poor growth, such as poor nutrition, emotional stress, or disease. After a physical exam and review of your child’s medical and family history, the doctor may look at his or her pattern of growth. They may order blood tests. If no signs of other conditions are present, the doctor may refer your child to a pediatric endocrinologist for further evaluation and testing.
For many parents, facing the possibility of growth hormone disorder leads to some worries, as well as many questions. By asking your questions and talking with your child’s doctor, you can decide the next steps together.
After the diagnosis.
After diagnosing your child with GHD, the doctor may recommend a treatment such as growth hormone, and will likely ask for regular follow-up visits to monitor your child’s growth and make sure that treatment is working well. Norditropin® is a great growth hormone treatment option.
Small for
Gestational Age
What does small for gestational age mean?
At birth, a baby’s weight and length are recorded. Babies with a birth weight and/or length below the 2.3rd percentile are classified as born small for gestational age (SGA).
Why is a child born SGA?
About 95,000 children born in the United States each year are shorter and lighter than normal. The cause is not always clear, but an infant may be born SGA because of a genetic defect, problems with the placenta, or health issues with the mother—such as heart disease, malnutrition, or drug, alcohol, or cigarette use.
Do babies born SGA “catch up”?
Babies born SGA should be carefully monitored for growth. Most will reach normal size and height by the time they’re 2 years old. Premature babies (born before 37 weeks of gestation) may take up to age 4 to catch up. If your child was born SGA, be sure to consult with your doctor about his or her growth.
If no catch-up growth happens by age 2 to 3, your child may need a referral to a pediatric endocrinologist, a doctor who specializes in hormone diseases in children. The endocrinologist will find out if there is any other reason, such as a nutritional problem or inherited disease, that is keeping your child from catching up in growth.
How is SGA diagnosed?
The doctor may take an X-ray of your child’s hand and wrist. The X-ray will show his or her bone age, which can help predict your child’s final adult height, and can show if your child still has room for growth.
For many parents, facing the possibility of a growth hormone disorder leads to some worries, as well as many questions. By asking your child’s doctor targeted questions, you can learn your options and decide on next steps together.
After the diagnosis
After diagnosing your child with SGA, the doctor may recommend certain treatments, which may help your child with catch-up growth. If treatment is recommended, your doctor will likely ask for regular follow-up visits to monitor your child’s growth and make sure that treatment is working well. Norditropin® is a great growth hormone treatment option.
Noonan
Syndrome
What is Noonan syndrome?
Noonan syndrome is a rare genetic disorder that affects both boys and girls. About 1 in 1,000 to 2,500 infants is born with Noonan syndrome, which can cause congenital heart disease, distinctive facial features, short stature, and other conditions.
Noonan syndrome affects both boys and girls. Up to 83% of patients with Noonan syndrome have short stature.
What causes Noonan syndrome?
Noonan syndrome is caused by a mutation, or abnormality, in one of several genes. In about half of Noonan syndrome cases, the mutation occurs in a gene contained on chromosome 12. There is a 50% chance that a parent with Noonan syndrome will pass the chromosome to their child.
What are the physical features of Noonan syndrome?
Up to 83% of patients with Noonan syndrome have short stature. At birth, a child with Noonan syndrome may have normal weight and length, but during childhood and/or puberty they may fall behind in height, weight, and bone age or maturation compared with the general population.
Certain physical traits and conditions may occur in Noonan syndrome. Some children with Noonan syndrome may have many of these conditions, while others have just a few:
- Heart defects.
- Abnormal bruising or bleeding.
- Unusual facial features (which may fade as a child grows), including wide-set eyes, down-slanting eyes, drooping eyelids, arched eyebrows, and low-set ears with forward-facing lobes.
- Delay in puberty.
- Poor eyesight.
- Chest and skeletal deformities.
- Webbed neck.
A low hairline at the back of the neck.
Learning disability or mild retardation.
Lymphatic abnormalities.
Undescended testicles in males at birth.
Brilliant blue or blue-green eyes.
Feeding difficulties in infancy.
Frequent or forceful vomiting in infancy.
Hearing problems.
Everyone is different:
Some children may have many of these features, while others have just a few. Because children with Noonan syndrome usually have more than one of these traits, most likely they will need to see other medical specialists, like a heart specialist (cardiologist) or an eye specialist (ophthalmologist).
What about puberty?
In children with Noonan syndrome, puberty can be delayed by about 2 years. The pubertal growth spurt is often reduced or absent. Bone development may also be delayed by 2 years.
How is Noonan syndrome diagnosed?
Today, there is no simple test that can diagnose a boy or girl with Noonan syndrome. The diagnosis is first made by recognizing the physical features of Noonan syndrome. After evaluation, a geneticist may confirm a diagnosis of Noonan syndrome with genetic testing.
After the diagnosis
If your child is diagnosed with Noonan syndrome, the pediatric endocrinologist may recommend a treatment such as growth hormone. And, they’ll probably ask to schedule regular follow-up visits with the appropriate specialist, to monitor your child’s growth, and other conditions.
Turner
Syndrome
What is Turner syndrome?
Turner syndrome is a genetic disorder in girls, which can cause short stature, ovarian failure, and certain health problems. It is a rare disorder, present in approximately 1 in 2,500 females.
Turner syndrome only affect girls. It is caused by a problem with one of the X chromosomes.
What causes Turner syndrome?
Inside every cell of our bodies are 23 pairs of chromosomes, which contain the genes that control traits such as eye color, hair color, and height. Turner syndrome is caused by a problem with a particular pair of chromosomes—the ones that determine a baby’s gender. Normally, girls have two X chromosomes, while boys have an X and a Y chromosome.
What are the physical features of Turner syndrome?
Turner syndrome may affect girls in different ways, but shorter-than-normal height is among the most common signs. In fact, more than 95% of adult women with Turner syndrome are shorter than average. Girls with Turner syndrome may start to slow down in their growth as early as 18 months of age, and continue to grow slowly through childhood.
Girls with Turner syndrome may share other common conditions:
- Heart defects.
- Short neck with a webbed appearance.
- Low hairline at the back of the neck.
- Differently shaped, low-set ears.
- High-arched palate.
- Drooping eyelids.
- Short stature.
- Ovarian failure.
- Broad chest.
- Lymphedema (puffy hands and feet).
You won’t see all of these traits in every girl with Turner syndrome—but most do have ovarian failure.
Surprising fact:
Short stature in girls with Turner syndrome is not due to a lack of growth hormone, but, for unknown reasons, the girl does not respond to the growth hormone she makes herself.
What about puberty?
Puberty is the time when a child’s body matures into an adult body. For girls with Turner syndrome who have ovarian failure, puberty doesn’t happen naturally on its own. And, they typically don’t experience the growth spurt that often accompanies puberty. Often, it’s the absence of this growth spurt or delay in puberty that may prompt a doctor to look for the presence of a condition that is preventing normal growth.
How is Turner syndrome diagnosed?
About one-third of patients with Turner syndrome are diagnosed as newborns due to puffy hands and feet (lymphedema) or thicker-than-normal neck skin. Another third are diagnosed in mid-childhood by their short stature, and other patients are diagnosed in adolescence when they fail to enter puberty or as adults because of recurrent pregnancy loss.
To diagnose Turner syndrome, your child may be referred to a pediatric endocrinologist, a doctor who specializes in hormone diseases in children. The pediatric endocrinologist will do a blood test to examine her genetic makeup. This test, called a “karyotype,” arranges the chromosomes to identify any that are missing. It also tells which are abnormally shaped or have missing pieces.
NEW BORN SYMPTOMS
MID-CHILD SYMPTOMS
LATER SYMPTOMS
Puffy hands and feet
Thick neck skin
Short stature
Failure to enter puberty or
recurrent pregnancy loss in adulthood
After the diagnosis
After diagnosing your child with Turner syndrome, your child’s pediatric endocrinologist may recommend a treatment such as growth hormone, and will likely ask for regular follow-up visits to monitor your child’s growth and make sure that treatment is working well.
We recommend the use of Norditropin®, a great growth hormone treatment option.
Adult Growth Hormone Deficiency
What is Adult Growth Hormone Deficiency?
Adults diagnosed with growth hormone deficiency (GHD) do not produce sufficient growth hormone. Growth hormone is made in the brain by the pituitary gland.
It’s responsible for more than just your height; growth hormone also helps keep your bones, muscles, and metabolism in balance. In children, growth hormone deficiency can result in a lack of growth. But for adults, a lack of growth hormone can affect their bodies in other ways.
What causes it?
About 50,000 adults in the United States have growth hormone deficiency, with about 6,000 new patients diagnosed each year.
Typically, there are two main causes:
Adults may become growth hormone deficient when the pituitary gland or hypothalamus is damaged.
This may happen as the result of disease, a head injury, a blocked blood supply, or after surgery or radiation treatment to treat tumors of the glands.
Adults may be diagnosed with growth hormone deficiency as children.
Some require treatment throughout life. And while most adults with GHD are diagnosed as children, some don’t find out they have growth hormone deficiency until they reach adulthood.
In up to 80% of adults diagnosed with GHD,
growth hormone deficiency is a result of damage to the pituitary gland or hypothalamus, most often caused by benign (non-cancerous) tumors called pituitary adenomas, or from certain treatments of these tumors. Rare causes of adult GHD include diseases such as sarcoidosis, tuberculosis, histiocytosis, and hemochromatosis (iron overload).
What are the signs of Adult Growth Hormone Deficiency?
Most children with growth hormone deficiency have obvious symptoms, such as short stature. But because adults have already reached their full height, the symptoms of adult growth hormone deficiency are different. Growth hormone deficiency can affect the proportion of fat, muscle, and bone in your body, so you may notice the following signs and symptoms:
- Increased fat, especially around the waist
- Decreased muscle mass
- Thinning bones
- Higher cholesterol, especially LDL (the “bad” cholesterol)
How is Adult Growth Hormone Deficiency diagnosed?
If your doctor suspects the possibility of adult GHD, he or she may refer you to an endocrinologist, a doctor who specializes in hormone disorders.
In order for the endocrinologist to confirm you have adult GHD, they may order a stimulation test, or “stim” test. During this test, a patient is given a medication that causes the pituitary gland to release larger amounts of growth hormone at once. Several blood samples are taken over a period of time, measuring the amount of growth hormone in the body. Your endocrinologist may need to do more than one stim test to accurately diagnose growth hormone deficiency.
After the diagnosis
Your endocrinologist may recommend treatment to augment the amount of growth hormone produced by your pituitary gland, and will likely ask for regular follow-up visits to make sure the treatment is working well.
Prader-Willi syndrome
What is Prader-Willi syndrome?
Prader-Willi syndrome (PWS) is a rare genetic disorder that affects both boys and girls. About 1 in 10,000 to 30,000 people worldwide are affected by PWS, which can cause childhood obesity as well as difficulties with learning, hormonal and neurological function, and behavior.
Prader-Willi syndrome affects both boys and girls. One in 10k-30k people worldwide are affected by it.
What causes Prader-Willi syndrome?
PWS results when certain genes located on an area of chromosome 15 are abnormal or missing. In most cases, children do not inherit PWS from their parents—the error in the genes just happens.
The signs of PWS vary throughout life. Babies with PWS have poor muscle tone and difficulty feeding. As they grow, they often experience an abnormally increased appetite, along with short stature. In later childhood, obesity-related complications may arise, along with scoliosis, epilepsy, and additional behavioral problems.
Children with PWS may have some or all of these characteristics:
In Infancy
- Poor muscle tone
- Lethargy
- Difficulty Feeding
- Slow growth
- Poor reflexes
In early childhood
- Facial features such as narrow forehead and almond-shaped eyes
- Puffy hands and fingers
- Delays in motor and language skills
- Learning disabilities
- Increased appetite
- Obesity
- Short stature due to reduced growth hormone secretion
- Behavior problems
In late childhood and adolescence
- Abnormally increased appetite
- Lack of satiety after eating
- Food-seeking behavior
- Obesity-related complications such as diabetes and sleep apnea
Surprising fact:
Many genetic disorders are inherited—passed down from parents to their children. But PWS is different. It occurs when genes from a baby’s father do not function properly. These errors in the genes happen randomly, so while PWS is rare, it can occur in any pregnancy.
What about puberty?
Both boys and girls with PWS experience a delay in puberty and lack the pubertal growth spurt typically seen during this phase of development.
How is Prader-Willi syndrome diagnosed?
Before genetic testing was developed, children were diagnosed based on exhibiting the characteristics of PWS such as lethargy and feeding problems in infancy or increased appetite and distinctive facial features in early childhood. Today, if PWS is suspected, the doctor may refer your child to a geneticist for genetic testing to confirm a diagnosis.
In addition, a pediatric endocrinologist may order a stimulation test, or “stim” test, to determine whether your child has growth hormone deficiency (GHD). During this test, a patient is given a medication that causes the pituitary gland to release larger amounts of growth hormone. Over a period of time, several blood samples are taken to measure the amount of growth hormone in the body.
NEW BORN SYMPTOMS
MID-CHILD SYMPTOMS
LATER SYMPTOMS
Poor muscle tone and lethargy Difficulty feeding
Narrow forehead and almond-shaped eyes Puffy hands and fingers
Abnormally increased appetite Lack of satiety after eating Behavior problems related to food
After the diagnosis
After diagnosing your child with PWS, the doctor may recommend a treatment such as growth hormone and will likely ask for regular follow-up visits to monitor your child’s growth and make sure that treatment is working well.
Idiopathic Short Stature
What is Idiopathic Short Stature?
Idiopathic short stature (ISS) is a term used when your child is very short compared with other children of the same age and there is no recognizable disorder, hormonal issue, or nutritional problem that would cause it.
What are the signs of ISS?
Children with ISS have normal birth weights and sufficient levels of growth hormone—which means they do not have growth hormone deficiency (GHD). Most children with ISS appear otherwise healthy and have normal body proportions. Often, short stature is the only feature present. If your child is diagnosed with ISS, there are medicines that may help.
Some signs of ISS are:
- Shorter height than the normal range, regardless of biological parents’ heights
- Slowing of growth rate
- Growth that is below the 3rd percentile
What about puberty?
Some boys and girls with ISS experience a delay in puberty, while others don’t.
How is ISS diagnosed?
Diagnosing your child with ISS means first ruling out other causes of short stature, such as GHD or a genetic disorder. Your child’s doctor will conduct a thorough personal and familial medical history and physical exam, which may include lab tests, along with measuring their height, arm span, and head circumference. Depending on the results of the examination, the doctor may make a referral to a pediatric endocrinologist for further testing—which may include genetic testing.
In addition, a pediatric endocrinologist may order a stimulation test, or “stim” test, to measure your child’s level of growth hormone. During this test, your child is given a medication that causes the pituitary gland to release larger amounts of growth hormone. Over a period of time, several blood samples are taken to measure the amount of growth hormone in the body. If your child’s growth hormone levels are normal, the diagnosis may be ISS.
In most cases, ISS is diagnosed by ruling out growth hormone deficiency as the cause of your child’s short stature.
After the diagnosis
After diagnosing your child with ISS, the doctor may recommend a treatment such as growth hormone and will likely ask for regular follow-up visits to monitor your child’s growth and make sure that treatment is working well.
Taking steps toward answers.
Many parents wonder when they should talk to their child’s doctor about his or her growth. To help you determine when and what to ask, we’ve put together a few suggestions, but always talk to your health care provider if you have concerns.
When to ask about growth
Your child’s growth should be regularly measured and plotted on a chart—for example, during routine physical examinations. If you or the doctor notice a lack of growth, your child should be measured more often to confirm whether there is an issue.
In general, you should ask your child’s doctor to specifically look at growth if your child:
- Is much shorter than his or her peers or classmates
- Is growing more slowly than their peers or classmates
- Is not outgrowing their clothes or shoes
What does accurate measurement look like?
To accurately track your child’s growth, the doctor may take some of these measurements:
- Length or height – for children 2 years of age and younger, length should be measured with an infantometer; for children 2 and over, height should be measured with a stadiometer
- Weight
- Head circumference – the length around your child’s head
- Arm span – the length from the tip of one hand to the other with outstretched arms
- The ratio between upper and lower body measurements
It’s important that measurements are done properly. For example:
- Some common practices, such as marking the examination paper, can be extremely inaccurate
- Children should stand straight, with hips and shoulders touching the flat surface behind them
- It’s important to remove the child’s shoes, jacket, and hair ornaments, and adjust hairstyles that impede measurement
About growth charts
Your child’s measurements will be plotted on a growth chart. Growth charts are used to document and create an ongoing picture of your child’s growth. Here’s what you should know:
- Growth charts are age–based and gender–specific
- Lines, called percentile curves or percentiles, show the percentage of children at the same height or weight for the age group
- Your child’s doctor will plot his or her height measurements on the chart and draw a line (called a “growth curve”) to connect the points
- The current percentile rank will be compared to previous measurements to identify any shifts in your child’s growth patterns
Questions to ask
Regular measuring and plotting is key to identifying if your child has a growth issue, but if you have any concerns, it’s important to let your child’s doctor know. Here are a few questions to get the ball rolling:
- Can you explain the measurements you’ve taken?
- My child’s percentile has fallen since the last measurement. Does that suggest an issue with my child’s growth?
- What are some possible causes for lack of growth?
- Should my child see a specialist?
Should I just wait to see a specialist?
A “wait and see” approach could delay potential identification of the cause of short stature—and referral to a specialist may lead to proper diagnosis and treatment.
Referral to a specialist
If there is a problem with your child’s growth, the doctor may run some tests to determine the cause. If it turns out to be a medical issue, ask about a referral to a specialist, such as a pediatric endocrinologist.
Endocrinologists are specially trained doctors who diagnose and treat diseases of the glands and hormone imbalances. Pediatric endocrinologists are also trained to diagnose and treat children with growth disorders.
Keep in mind, early recognition of abnormal growth patterns, along with referral to a specialist, may offer the greatest opportunity for proper diagnosis and treatment.
What to expect at the specialist
Short stature is a common reason for a child to see a specialist, such as a pediatric endocrinologist. But remember, only a small number of children actually have growth disorders. If you and your doctor have decided to take the next step and have a pediatric endocrinologist examine your child, you can move toward identifying and addressing the issue, if one indeed exists.
The evaluation
Diagnosing the cause behind your child’s growth problem is accomplished through an evaluation and some diagnostic tests. Every child is different, so the pediatric endocrinologist will choose an evaluation that best suits your child. They may ask for any or all of the following information:
Medical history
- Mother’s nutrition and use of alcohol, nicotine, or other drugs during pregnancy
- Birth length and weight compared to gestational age
- Prior medical records from your child’s primary care physician, including past growth measurements, illnesses, surgeries, or hospitalizations
Emotional development
- Eating and playing habits
- School performance
- Participation in social events
- Emotional or physical traumas
Family history
- Information on birth parents
- When birth parents went through puberty
- Diseases (such as celiac disease) that run in the parents’ families
Physical examination
A complete physical exam will include measuring height and weight. Other measurements may include:
- Head circumference – the length around your child’s head
- Arm span – the length from the tip of one hand to the other with outstretched arms
- The ratio between upper and lower body measurements
- Sitting height
- Body composition (percent of lean muscle and fat)
Evaluation of growth
Using a growth chart, the doctor or nurse will compare your child’s height and weight with the statistical norm. This is the average height and weight of children who are the same age and sex.
Diagnostic tests
Lab tests
Blood tests may be ordered to evaluate your child’s general health, and to rule out medical conditions such as celiac disease, cystic fibrosis, and Crohn’s disease as the cause of your child’s growth issue.
The stimulation (“stim”) test
Some doctors use stimulation testing to check for growth hormone deficiency in children and adults. Because the pituitary gland releases different amounts of growth hormone throughout the day, a single test won’t accurately measure the amount of growth hormone in the blood. A stim test can tell us whether the pituitary gland releases the appropriate amount of growth hormone in response to stimulation.
Radiology evaluation
The doctor may perform tests that see inside the body, such as:
- X–rays
- Magnetic resonance imaging (MRI) test
- Computed tomography (CT) scans
- A bone age X–ray
The bone age X–ray is an important test to tell the doctor whether your child’s bones are developing at the right rate for his or her age. It can also show if your child still has room for growth.
If a diagnosis is made
If your pediatric endocrinologist determines that your child has a growth disorder, you will probably have lots of questions. Here are a few you may want to ask:
- What has my child been diagnosed with?
- How long will my child have this condition?
- What will the impact of this condition be on my child’s life?
- What can I do as a parent to help manage my child’s condition?
- Will my child need treatment and what will the treatment involve?
After your child is diagnosed, you’ll be presented with your options, which may include growth hormone therapy. Your pediatric endocrinologist and your health care team will assist you in developing a care plan that is best suited to your child.
Questions for the specialist
Receiving a diagnosis of growth hormone disorder isn’t easy, but for many children, it’s also the first step to treatment. When weighing the pros and cons of taking that step, it’s helpful to have as much information as possible. Here are some treatment-related questions you may want to ask the pediatric endocrinologist:
- If we were to start my child on growth hormone, when will we start to see growth?
- How much growth should we expect to see?
- How long would my child remain on treatment?
- Does my child have any risk factors?
- Are there side effects we should be aware of?
- Are there any safety concerns I should know about before using growth hormone treatment?
- What are the differences between the available therapies?
- What should we know about storing, handling, and traveling with treatment?
- Are there pros and cons of the various delivery devices?
- If we start treatment, would there be patient services available?
- What about financial assistance?
- What can you tell me about insurance coverage?
Questions about growth
Find answers to some of the most common questions about growth hormone-related disorders and treatment. If you still have questions, and can’t find the answers on this website, be sure to ask your doctor.
Growth Hormone Therapy
What is growth hormone?
Hormones are chemical messengers produced in one part of the body that travel to another part of the body to create some sort of change. Growth hormone is made in the pituitary gland, at the base of the brain, and is very important in helping children grow.
How does growth hormone work?
When growth hormone is released from the pituitary gland, it makes the liver release a second hormone called insulin-like growth factor-1 (IGF-1). Together, growth hormone and IGF-1 tell the bones, muscle, and many other organs and tissue to grow by adding more cells. The growth of the bones also requires bone cells to add minerals such as calcium and phosphate, which results in bones that are strong and long.
Growth Hormone Deficiency
What is growth hormone deficiency?
A deficiency means there is not enough of something. Growth hormone deficiency means just that: your body is not making enough growth hormone.
What could happen if growth hormone deficiency is not treated?
Lack of treatment for growth hormone deficiency could result in a child being significantly shorter than they otherwise would be when they reach adulthood. Adults who are not treated for GHD may have changes in the body such as weakening of bones, decrease in amount of muscle, and increase in fat and cholesterol.
How is growth hormone deficiency diagnosed?
Usually an endocrinologist (a doctor who specializes in the study of the hormone system in your body) will be able to tell if you have growth hormone deficiency. The doctor will ask many questions about your health and growth history and about the health and growth history of your family. You will have a physical exam. The doctor may also order a growth hormone stimulation test, or “stim” test.
There are different types of growth hormone stimulation tests. Some are able to measure the level of growth hormone when it is at its highest, for example, after sleep or exercise, because both of these activities increase the level of growth hormone. Another type of test uses a medicine to make the pituitary gland release growth hormone. If the pituitary does not produce growth hormone in response to this “stimulation,” it is a sign that the person has a deficiency.
How can I learn more about growth hormone deficiency?
There are several organizations dedicated to education, awareness, and advocacy for people with growth-related disorders.
The Stimulation (“STIM”) Test
What is a stim test?
The pituitary gland produces growth hormone in different amounts at different times of the day. This makes it difficult to test the amount of growth hormone the pituitary gland is releasing with just one blood sample. So, endocrinologists perform what is called a stimulation test, or “stim” test, which uses a series of blood samples to get a more accurate picture.a There is no one approved method for stim testing, but here’s an example of what might occur (talk with your health care provider for specific information):
- Your child will be given an IV and the first blood sample will be taken.
- Then, the stimulating medicine will be given. Your child will be closely monitored for any side effects that may occur.
- Blood samples will be taken over the next few hours. Your child will be able to rest or do quiet activities during this time
- When the last blood sample has been taken and the test is over, the IV will be removed.
- The doctor will communicate with you about when you’ll receive the results of the test and what the next steps will be.
a With all medicines, there are benefits to using them; however, there may be side effects. The medicines used during the stim test may cause side effects. If you have any questions, ask your health care provider.
How do we prepare for the stim test?
Explain the test to your child, including why it’s being given. Talk about the IV. You may want to demonstrate on a doll. Your child’s doctor will likely recommend that he or she not eat and limit physical activity for 10-12 hours before the test, to avoid changing the results.
Keep in mind that the test will take at least several hours and sometimes can take most of a day. You might consider bringing activities for yourself and your child to keep busy while you’re waiting.
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