GROWTH ASSESSMENT / GROWTH DISORDERS(A GUIDE FOR PARENTS AND PATIENTS)

GP Promotes the growth of muscle and bones, while the shift of lipid metabolism tends to be in the opposite direction. So, although a child’s appetite often increases, body fat may decrease with GH treatment. This is because GH contributes to the breakdown of fat at the same time the child is using more calories for growth of bone, muscle and other supporting tissues.

A small percentage of children receiving GH develop a low level of weak antibodies to the medication. This means that the body recognizes the GH as a foreign protein. These antibodies are rarely of any significance, although a high level of strong antibodies can block the action of GH. if this occurs, treatment is stopped temporarily and restarted with a different brand of GH.

In some children, the need for GH therapy results from treatment they received for leukemia or a brain tumor. Based on information collected from around the world, it does not appear that GH treatment increases the risk of relapse or recurrence in these children; relapse rates are similar in children who have received GH and those who have not GH has not been associated with an increased risk of cancer in childhood.

Several cases of benign intracranial hypertension (IC) have been reported in children starting GH starting treatment. IC results from increased pressure in the brain and can produce symptoms such as headaches, visual changes, nausea and vomiting. Most reported cases have occurred within the first 8 weeks of treatment and resolved after stopping GH or reducing the does.

Psychological effects of GH:

The overall psychological effects of GH therapy are positive; an increased growth rate, more mature appearance and the hope for an adult height within the normal range are viewed as positive by both parents and children. Even seemingly trivial milestones, such as being able to reach a light switch, give beneficial reinforcement.

Some children expect too much from GH - they think they will grow overnight or become the tallest in their class. When these expectations are not met, the child may feel dissapointed, depressed, or even guilty. The response to GH is individualized and depends on many factors.

Although self-esteem and body image may improve as the child begins to catch up to peers in size, GH does not cure behavior problems or remove all the child’s stress.

It’s not unusual for young children to regress temporarily after starting on GH (bed-wetting, thumb-sucking, irritability); older children may complain of headaches, stomachaches, or fatigue.

Safety profile of GH:

• The therapeutic benefit of growth hormone (GH) therapy in improving height in short children is widely recognized, however,GH therapy is associated with other metabolic actions that may be of benefit in these children. Beneficial effects of GH on body composition have been documented in several different patient populations as well as improvements in lipid profile. Marked augmentation of bone mineral density also seems evident in many pediatric populations.
• GH treatment also has beneficial on bone metabolism and BMD in children with GHD and in other indications and hence may be important in alleviating the risk for fracture that are associated with some of these conditions in adult life.
• A beneficial effect of GH treatment on plasma lipoprotein profiles has been documented in children with GHD and in short children who were born SGA.
• Moreover, GH therapy dose not seem to have adverse cardiac effects in children.
• Adverse effects related to fluid retention are generally transient or may be resolved with GH dose adjustment.
• No evidence of an excess of de novo cancers and no increase in observed cancer risk have been shown. Careful management of episodes of adrenal insufficiency or hypoglycemia is warranted.
• In summary, although the main role of GH replacement therapy in a pediatric population is generally considered to be an improvement of height, it is evident that this linear growth is accompanied by a number of beneficial metabolic effects in these patients.