Growth Hormone Deficiency in Children

Symptoms of growth hormone deficiency depend on various factors such as the child's age and the cause.

Children have poor overall growth rates, usually below 2 inches (5 centimeters) per year, and most have short stature but normal upper and lower body proportions. Some children may have a delay in tooth development or a delay in puberty Delayed Puberty Delayed puberty is defined as absence of the start of sexual maturation at the expected time. Most often, children simply develop later than their peers but ultimately develop normally. Sometimes... read more .

Other abnormalities may be present depending on the cause of the growth hormone deficiency. Newborns with growth hormone deficiency may have low blood sugar (hypoglycemia), jaundice Jaundice in the Newborn Jaundice is a yellow color to the skin and/or eyes caused by an increase in bilirubin in the bloodstream. Bilirubin is a yellow substance formed when hemoglobin (the part of red blood cells... read more (hyperbilirubinemia), or other congenital abnormalities such as a small penis (micropenis) in males or face defects (such as a cleft palate Cleft Lip and Cleft Palate A cleft is an opening that can form in the lip (cleft lip), roof of the mouth (cleft palate), or both if the tissue does not join together completely during pregnancy. Cleft lip and cleft palate... read more ). Children may also have symptoms of other hormone deficiencies such as central hypothyroidism Congenital hypothyroidism Hypothyroidism is decreased production of thyroid hormone. Hypothyroidism in children usually occurs when there is a structural problem with the thyroid gland or the thyroid gland is inflamed... read more .

Growth hormone levels in the blood vary widely and are not as useful as other hormone levels in determining why a child's growth is decreased. Thus, doctors make the diagnosis based on a collection of findings.

First, doctors measure the child's height and weight and plot the measurements on age-specific growth charts Length and Height Physical growth refers to an increase in body size (length or height and weight) and in the size of organs. From birth to about age 1 or 2 years, children grow rapidly. After this rapid infant... read more to determine whether they are growing too slowly. Then they often do x-rays of bones in the hand. Such x-rays can show if the bones are developing normally for the child's age. Children who are simply short have normal bone development for their age. Children who have growth hormone deficiency have delayed bone development. Delayed bone development can also occur in other conditions, such as hypothyroidism Hypothyroidism in Infants and Children Hypothyroidism is decreased production of thyroid hormone. Hypothyroidism in children usually occurs when there is a structural problem with the thyroid gland or the thyroid gland is inflamed... read more and delayed puberty Delayed Puberty Delayed puberty is defined as absence of the start of sexual maturation at the expected time. Most often, children simply develop later than their peers but ultimately develop normally. Sometimes... read more .

It is difficult for doctors to assess growth hormone production because production fluctuates throughout the day. As a result, measurement of random growth hormone levels is often not helpful. Instead, doctors do blood tests to measure levels of other substances in the blood that are stimulated by growth hormone. Such substances include insulin-like growth factor 1 and insulin-like growth factor binding protein 3. However, these substances may be affected by other conditions, such as hypothyroidism Diagnosis Hypothyroidism is decreased production of thyroid hormone. Hypothyroidism in children usually occurs when there is a structural problem with the thyroid gland or the thyroid gland is inflamed... read more , celiac disease Celiac Disease Celiac disease is a hereditary intolerance to gluten (a protein found in wheat, barley, and rye) that causes characteristic changes in the lining of the small intestine, resulting in malabsorption... read more , and undernutrition Diagnosis Undernutrition is a deficiency of calories or of one or more essential nutrients. Undernutrition may develop because people cannot obtain or prepare food, have a disorder that makes eating or... read more , so doctors may do tests to rule out these conditions.

Other laboratory tests are done to look for other causes of poor growth (such as thyroid, blood, kidney, inflammatory disorders, and immune disorders). Genetic testing may be done if doctors suspect the child has a specific syndrome (such as Turner syndrome Turner Syndrome Turner syndrome is a sex chromosome abnormality in which girls are born with one of their two X chromosomes partially or completely missing. Turner syndrome is caused by the deletion of part... read more ).

If test results suggest that the child has a pituitary disorder, imaging tests of the brain using magnetic resonance imaging Magnetic Resonance Imaging (MRI) In magnetic resonance imaging (MRI), a strong magnetic field and very high frequency radio waves are used to produce highly detailed images. MRI does not use x-rays and is usually very safe... read more (MRI) may be done to look for structural abnormalities in the pituitary gland and for tumors.

If children have no other cause of poor growth and their growth hormone levels are low, doctors typically do a stimulation test. The stimulation tests involve giving drugs that stimulate growth hormone production, then measuring growth hormone levels over several hours.

Children are given injections of synthetic growth hormone. Injections traditionally are given once a day, but a newer form of growth hormone is injected once a week. The hormones are given until children reach an acceptable height or until children do not grow more than 1 inch (about 2.5 centimeters) in a year. During the first year of treatment, children may grow up to 4 to 5 inches (10 to 12 centimeters), but individual responses vary.

Children do not usually have side effects from growth hormone therapy, although some develop mild swelling of the limbs that usually resolves quickly or infrequently develop more serious side effects such as increased pressure in the brain (idiopathic intracranial hypertension) Idiopathic Intracranial Hypertension Idiopathic intracranial hypertension is characterized by increased pressure within the skull (intracranial pressure). What triggers the disorder is unknown. People have daily or near daily headaches... read more or a problem in the upper thigh bone that can show up as knee or hip pain or limping (slipped capital femoral epiphysis Slipped Capital Femoral Epiphysis (SCFE) Slipped capital femoral epiphysis is a slippage or separation of the end of the thighbone (femur) at its growth plate in the hip joint. This disorder may be caused by a weakened growing hip... read more ).

Growth hormone also may be used to increase height in children who are short but have normally functioning pituitary glands, but this use is controversial. Some parents feel that short stature is a disorder, but many doctors do not approve of the use of growth hormone in these children. Regardless of the cause of short stature, growth hormone is effective only if given before the bones stop growing.

If identified, some brain tumors can be removed surgically, but children are at high risk of hypopituitarism because surgery may damage the pituitary. Children who have hypopituitarism are given hormones to replace the ones they are lacking (see treatment of hypopituitarism Treatment Hypopituitarism is an underactive pituitary gland that results in deficiency of one or more pituitary hormones. Symptoms of hypopituitarism depend on what hormone is deficient and may include... read more ).