64.Growth Hormone Deficiency
64.Growth Hormone Deficiency
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COURSE NUMBER: 64
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1 Clinical Aspects of Growth Hormone Deficiency in Adults. An Overview
Jørgensen, J.O.L.; Christiansen, J.S. (Aarhus)
21 Epidemiology of Adult Growth Hormone Deficiency. Prevalence, Incidence,
Mortality and Morbidity
Erfurth, E.M. (Lund)
33 Hypopituitarism following Traumatic Brain Injury
Popovic, V. (Belgrade); Aimaretti, G. (Turin);
Casanueva, F.F. (Santiago de Compostela); Ghigo, E. ( Turin)
45 IGF-I Measurements. Epidemiological and Clinical Aspects
Juul, A. (Copenhagen)
68 Diagnosis of Growth Hormone Deficiency
Fisker, S. (Aarhus); Andersen, M. (Odense); Ørskov, H. (Aarhus)
86 Clinical Monitoring of Growth Hormone Replacement in Adults
Gibney, J. (Dublin); Johannsson, G. (Gothenburg)
103 Consequences of Growth Hormone Deficiency for Intermediary
Metabolism and Effects of Replacement
Nørrelund, H. (Aarhus)
121 Skeletal and Cardiac Muscle in Adults with Growth Hormone Deficiency
Cuneo, R.C.; Wallace, J.D. (Brisbane)
146 Bone Metabolism and Growth Hormone Deficiency. Experimental and Clinical
Ueland, T.; Bollerslev, J. (Oslo)
161 Growth Hormone and Fluid Homeostasis
Møller, J. (Aarhus)
185 Growth Hormone and Body Composition
Mersebach, H.; Feldt-Rasmussen, U. (Copenhagen)
196 Effects of Growth Hormone Deficiency and Growth Hormone Treatment
on Quality of Life in Growth Hormone-Deficient Adults
Arwert, L.I.; Deijen, J.B.; Drent, M.L. (Amsterdam)
209 Safety Aspects of Growth Hormone Replacement
Waterhouse, M.; Monson, J.P. (London)
222 Author Index
223 Subject Index
Growth Hormone Deficiency
A growth hormone deficiency (GHD) occurs when the pituitary gland doesn’t produce enough growth hormone. It more commonly affects children than adults.
The pituitary gland is a small gland about the size of a pea. It’s located at the base of the skull and secretes eight hormones. Some of these hormones control thyroid activity and body temperature.
GHD occurs in roughly 1 in 7,000 births. The condition is also a symptom of several genetic diseases, including Turner syndrome and Prader-Willi syndrome.
You may grow concerned if your child is not meeting height and weight growth standards. Growth hormone deficiency is treatable. Children who are diagnosed early often recover very well. If left untreated, the condition can result in shorter-than-average height and delayed puberty.
Your body still needs growth hormone after you’ve finished puberty. Once you’re in adulthood, the growth hormone maintains your body structure and metabolism. Adults can also develop GHD, but it isn’t as common.
What Causes Growth Hormone Deficiency?
Children with cleft lips or cleft palates often have poorly developed pituitary glands, so are more likely to have GHD.
GHD that isn’t present at birth may be caused by a tumor in the brain. These tumors are normally located at the site of the pituitary gland or the nearby hypothalamus region of the brain.
In children and adults, serious head injuries, infections, and radiation treatments can also cause GHD. This is called acquired growth hormone deficiency (AGHD).
Symptoms of Growth Hormone Deficiency
Children with GHD are shorter than their peers and have younger, rounder faces. They may also be chubby or have “baby fat” around the abdomen, even though their body proportions are normal.
If GHD develops later in a child’s life, such as from a brain injury or tumor, its main symptom is delayed puberty. In some instances, sexual development is halted.
Many teens with GHD experience low self-esteem due to developmental delays such as short stature or a slow rate of maturing. For example, young women may not develop breasts and young men’s voices may not change at the same rate as their peers.
Reduced bone strength is another symptom of AGHD. This may lead to more frequent fractures, especially in older adults. People with low growth hormone levels may feel tired and lack stamina. They may experience sensitivity to hot or cold temperatures.
A variety of psychological symptoms can occur, including:
• lack of concentration
• poor memory
• bouts of anxiety or emotional distress
Adults with AGHD typically have high levels of fat in the blood and high cholesterol. This isn’t due to poor diet, but rather to changes in the body’s metabolism caused by low levels of growth hormone. Adults with AGHD are at greater risk for diabetes and heart disease.
How Is Growth Hormone Deficiency Diagnosed?
Your child’s doctor will look for signs of GHD if your child is not meeting their height and weight milestones. They’ll ask you about your growth rate as you approached puberty, as well as your other children’s growth rates. If they suspect GHD, a number of tests can confirm the diagnosis.
A blood test can measure growth hormone in the body. However, your levels of growth hormone fluctuate widely throughout the day and night (called “diurnal variation”). A blood test with a lower-than-normal result is not enough evidence to make a diagnosis.
Growth plates are the developing tissue at each end of your arm and leg bones. Growth plates fuse together when you’ve finished developing. X-rays of your child’s hand can indicate their level of bone growth.
Kidney and thyroid function tests can determine how the body is producing and using hormones.
If your doctor suspects a tumor or other damage to the pituitary gland, an MRI imaging scan can provide a detailed look inside the brain. Growth hormone levels will often be screened in adults who have a history of pituitary disorders, have a brain injury, or need brain surgery.
Testing can determine if the pituitary condition was present at birth or brought on by an injury or tumor.
How Is Growth Hormone Deficiency Treated?
Since the mid-1980s, synthetic growth hormones have been used with great success to treat children and adults. Before synthetic growth hormones, natural growth hormones from cadavers were used for treatment.
Growth hormone is given by injection, typically into the body’s fatty tissues, such as the back of the arms, thighs, or buttocks. It’s most effective as a daily treatment.
Side effects are generally minor, but may include:
• redness at the injection site
• hip pain
• curving of the spine (scoliosis)
In rare cases, long-term growth hormone injections may contribute to the development of diabetes, especially in people with a family history of that disease.
Children with congenital GHD are often treated with growth hormone until they reach puberty. Often, children who have too little growth hormone in their youth will naturally begin to produce enough as they enter adulthood. However, some remain in treatment for their entire lives. Your doctor can determine if you need ongoing injections by monitoring hormone levels in your blood.
What Is the Long-Term Outlook for GHD?
Make an appointment with your doctor if you suspect that you or your child is deficient in growth hormones. Many people respond very well to treatment. The sooner you start treatment, the better your results will be.
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