Growth hormone therapy refers to the use of growth hormone (GH) as a prescription medication.
In the past, growth hormone was extracted from human pituitary glands.
It is now produced by recombinant DNA technology.
Growth hormone deficiency is treated by replacing GH.
GH being a large peptide molecule, requires injection into subcutaneous tissue or muscle to get it into the blood.
After GH, a deficient child will begin to grow faster within months, develop increased strength, progress in motor development, and causes a reduction of body fat.
Side-effects of GH replacement are quite rare.
Treatment involves daily s.c. injections of growth hormone, usually for as long as the child is growing.
Monitoring growth with dose modifications every 3-4 months.
Adult patients with growth hormone deficiency should be administered an individualized GH treatment regimen.
Adults patients with structural hypothalamic/pituitary disease, surgery or irradiation in these areas, head trauma, or evidence of other pituitary hormone deficiencies be considered for evaluation for acquired GH deficiency.
Idiopathic GH deficiency in adults is very rare.
In adult patients with GH deficiency replacement therapy can provide a number of measurable benefits: improved bone density, increased muscle mass, decrease of adipose tissue, faster hair and nail growth, strengthened immune system, increased circulatory system, and improved blood lipid levels, but long term mortality benefit has not yet been demonstrated.
GH is approved for adults with cachexia caused by AIDS.
Turner syndrome response of non-deficient shortness, at doses 20% higher than those used in GH deficiency, growth accelerates with median gain in adult height is about 2-3 in.
The growth gain in Turner syndrome appears to be dose-dependent.
Chronic kidney failure in children includes growth failure, and GH before and after transplantation may prevent further deceleration of growth and may narrow the height deficit.
In Prader-Willi syndrome GH can help children with height, weight, body mass, strength, and agility.
Children who are short because of intrauterine growth retardation are small for gestational age at birth for a variety of reasons. If early catch-up growth does not occur and their heights remain below the third percentile by 2 or 3 years of age, adult height is likely to be similarly low. High-dose GH treatment has been shown to accelerate growth, but data on long term benefits and risks are limited.
Idiopathic short stature (ISS) terminology has been applied to children with severe unexplained shortness that will result in an adult height below the 3rd percentile.
A study of GH given to severely ill adults in an intensive care unit setting for the purpose of increasing strength and reducing the muscle wasting of critical illness showed a higher mortality rate for the patients having received GH.
GH treatment usually decreases insulin sensitivity.
A French study: certain kinds of short stature (idiopathic growth hormone deficiency treated with recombinant human growth hormone during childhood and who were followed over a long period of time, were at a small increased risk of death when compared to individuals in the general population of France.
Between 1985 and 2003, a total of 26 cases of Creutzfield-Jacob disease occurred in adults having received pituitary derived GH before 1977.
Genentech’s recombinant human growth hormone, which was introduced in 1985.
Turner syndrome and chronic kidney failure were the first of these nonGH-deficient causes of shortness to receive GH treatment, and Prader-Willi syndrome and intrauterine growth retardation followed.
Common problems with adults and GH deficiency are: impaired physical, mental, and social energy, excess adipose and diminished muscle, diminished libido, poor bone density, higher cholesterol levels, and higher rates of cardiovascular disease.
GH could improve nearly all of the above factors.
Recombinant growth hormone available in the U.S. by a number of companies with nearly identical composition, efficacy, and cost.
Somapacitan-beco (Sogroya) is a once-per week subcutaneous human growth hormone (hGH) therapy.
Recombinant human growth hormone, somatropin’s amino acid sequence is identical with that of endogenous human GH.
Growth hormone off label use has not proved to be efficacious, and there is no compelling evidence that it is beneficial except for acute fat loss in otherwise healthy adults.
Growth hormone therapy is approved for treating HIV associated cachexia, which induces a positive nitrogen balance and muscle mass with decreased fat.
Metabolic syndrome, diabetes and hypertension may develop over a period of 10 years with the use of growth hormone.
The use of growth hormone to enhance athletic performance is illegal, and not ethically or scientifically justified and has been improperly used by athletes to achieve competitive performance advantage.
The use of growth hormone not been shown to have clinical benefits for improving competitive performance.