Pediatric Endocrine Society Provides Guidance for Growth Hormone Use in Pediatric Patients

HealthDay News—Use of growth hormone in children and adolescents should be considered carefully, with assessment of the risks and benefits necessary for each patient, according to guidelines published in the January issue of Hormone Research in Paediatrics.

Adda Grimberg, MD, from the Perelman School of Medicine at the University of Pennsylvania in Philadelphia, and colleagues updated guidelines on the use of growth hormone, focusing on idiopathic short stature (ISS), GH deficiency (GHD), and primary insulin-like growth factor-I (IGF-I) deficiency (PIGFD). The guidelines were written on behalf of the Pediatric Endocrine Society.

The researchers recommend use of growth hormone for children and adolescents with GHD. Prospective recipients of growth hormone treatment should receive guidance regarding potential adverse effects and should be monitored for these effects. Parents and clinicians should take a shared decision-making approach to treating patients with ISS, and assess the physical and physiological burdens for the child, while considering the risks and benefits of treatment.Follow-up assessment of benefit and psychosocial impact should be conducted at 12 months after initiation and dose optimization of GH. IGF-I therapy is recommended for patients with severe PIGFD. Diagnosis of PIGFD/GH insensitivity syndrome should be based on a combination of factors that fall into four stages.

Physicians with expertise in managing endocrine disorders in children should provide consultation for evaluation of GHD-ISS-PIGFD and manage treatment.

“The taskforce suggests that the recommendations be applied in clinical practice with consideration of the evolving literature and the risks and benefits to each individual patient,” the authors write. “In many instances, careful review highlights areas that need further research.”

Several authors disclosed financial ties to the pharmaceutical industry.


Grimberg A, DiVall SA, Polychronakos C, et al; on behalf of the Drug and Therapeutics Committee of the Pediatric Endocrine Society. Guidelines for growth hormone and insulin-like growth factor-I treatment in children and adolescents: growth hormone deficiency, idiopathic short stature, and primary insulin-like growth factor-I deficiency. Horm Res Paediatr. 2016;86(6):361-397. doi: 10.1159/000452150


Growth Hormone Deficiency Following Complicated Mild Traumatic Brain Injury

Traumatic brain injury (“TBI”) is considered the main cause of hypopituitarism in adults and growth hormone (“GH”)deficiency is the most common pituitary deficit associated with TBI.

According to Cedars-Sinai, even after we stop growing, adults need growth hormone. Growth hormone plays a role in healthy muscle, how our bodies collect fat (especially around the stomach area), the ratio of high density to low density lipoproteins in cholesterol levels, and bone density. In addition, growth hormone is needed for normal brain function.

A recent study aimed to assess pituitary function and GH deficiency in adult patients at different time durations following complicated mild TBI, according to the Glasgow Coma Scale (GCS). The study also aimed to evaluate whether mild TBI patients with GH deficiency had developed alterations in the glycolipid profile.

Forty-eight patients (34 men and 14 women) with complicated mild TBI were included in the study. Twenty-three patients were evaluated at 1 year (Group A), and 25 patients at 5 years or longer after the injury (Group B). All patients underwent basal hormonal evaluation for pituitary function. GH deficiency was investigated by the combined test (GH releasing hormone + arginine). The glycolipid profile was also evaluated.

Researchers report that GH deficiency occurred in 8/23 patients (34.7 percent) of Group A and in 12/25 patients (48 percent) of Group B. In addition, two patients, one in each group, showed evidence of central hypothyroidism. Patients examined one-year or several years after complicated mild TBI had a similarly high occurrence of isolated GH deficiency, which was associated with visceral adiposity and metabolic alterations.

These findings suggest that patients with complicated mild TBI should be evaluated for GH deficiency even if several years have passed since the underlying trauma.


Signs and Symptoms of Adult Growth Hormone Deficiency

Major Symptoms of Adult-Onset Growth Hormone deficiency

You may be wondering if the unusual symptoms you are feeling lately may be due to growth hormone deficiency. Growth hormone is now widely recognized as an important factor in the maintenance of health and well-being. However, research shows that most people won’t experience the debilitating effects of growth hormone deficiency during their lifetime as the condition is not a cause of aging but rather serious illness or injury. If you want to learn about growth hormone deficiency signs and symptoms and what clinics like the Nexel Medical can do about this problem, keep reading.

About growth hormone deficiency in children

Growth hormone deficiency manifests differently in childhood than it does in adulthood. For normal development, there needs to be an adequate amount of circulating growth hormones in the body. The main symptom of growth hormone deficiency in children is stunted growth and developmental problems. This is a result of insufficient amounts of this important hormone in the body that is normally secreted by the pituitary gland. The pituitary gland is a small gland located at the bottom of the hypothalamus, at the base of the brain. Any damage to the pituitary gland will cause a drop in growth hormone levels that could be dangerous for children.

Growth hormone deficiency in adults

Although it would be natural to assume that there is no need for a growth hormone in the body once the growth process is over and we’ve reached adult height and weight, this is simply not the case. The human growth hormone plays a vital role in overall health up until old age. Damage to the pituitary gland from tumors is the most common cause of growth hormone deficiency in adults. People also tend to experience a decline in growth hormone levels that naturally come with age, but researchers agree that this decline is insignificant and shouldn’t cause any problems. However, damage to the pituitary gland will definitely cause major symptoms that require immediate treatment from clinics such as the Nexel Medical. According to an article published in the Indian Journal of Endocrinology and Metabolism, growth hormone deficiency has been associated with abnormalities of:

  • Neuropsychiatric and cognitive functioning

  • Cardiovascular functioning

  • The neuromuscular system

  • The skeletal system

Metabolic functioning

All these problems can be significantly reversed with growth hormone therapy. Growth hormone is now widely recognized as a hormone playing a role in the regulation of body composition, energy levels, and normal mental functioning.

Causes and symptoms of growth hormone deficiency

According to current research, 65% of all cases of growth hormone deficiency are caused by pituitary tumors. Other common causes are infections of the pituitary gland, pituitary hemorrhage, and idiopathic growth hormone deficiency. Traumatic brain injury may also lead to growth hormone deficiency in some cases. The clinical features or signs and symptoms of growth hormone deficiency are many and may seem unspecific at first. Those suspecting problems with the pituitary gland and growth hormone deficiency should look out for the following:

  • Cognitive changes (memory, processing, speed, attention)

  • Mood changes (depression, anxiety)

  • Social withdrawal

  • Fatigue and lack of strength

  • Neuromuscular dysfunction

  • Decreased bone mineral density

  • Decreased sweating

  • Weight gain and muscle loss

  • Metabolic changes (insulin resistance, dyslipidemia)

  • Treatment of growth hormone deficiency

Growth hormone deficiency in adults is usually treated with growth hormone replacement therapy. The hormone is in such cases administered intravenously or through dermal implants. A study published in the Journal of Clinical Endocrinology and Metabolism found that administering growth hormone to patients with growth hormone deficiency resulted in a reduction of visceral body fat by 30%. The researchers also noticed an improvement in bone metabolism and a decline in psychiatric complaints in these patients.

Why growth hormone pills don’t work?

Taking oral supplements claiming to contain the human growth hormone won’t work simply because the majority of it will be digested by your gastrointestinal tract before it gets the chance to reach your bloodstream. This is mainly because the human growth hormone is a protein and all proteins are broken down by the digestive tract. This was confirmed by studies as stated in an FDA-published article explaining how growth hormone administered to dairy cows cannot affect humans.


The human growth hormone is an important hormone for the maintenance of health, metabolism, and mental functioning. Studies on growth hormone deficiency show that most people have adequate levels of this hormone in their bodies. Although a decline in growth hormone levels comes with age, this decline is not enough to cause major changes in a person’s health and well-being. On the other hand, structural damage to the pituitary gland will cause some of the major conditions and symptoms of growth hormone deficiency. In such cases, growth hormone replacement therapy is highly advised. Clinics such as Nexel Medical are among many that offer different hormone replacement therapies including for growth hormone deficiencies.


Hormone Replacement Therapy Clinic


Familial isolated pituitary adenoma (AIP study)

Professor Márta Korbonits is the Chief Investigator for the NIHR Clinical Research Network supported familial pituitary adenomas study (AIP) which is investigating the cause, the clinical characteristics and family screening of this relatively recently established disease group.

Please tell us about the condition in layman’s terms?
Pituitary adenomas are benign tumours of the master gland of the body, the pituitary gland. It is found at the base of the brain. The most commonly identified adenoma type causing familial disease makes excess amounts of growth hormone, and if this starts in childhood the patient have accelerated growth leading them to become much taller than their peers. This condition is known as gigantism.

How rare is this condition?
Pituitary adenomas cause disease in 1 in a 1000 person of the general population. About five to seven percent of these cases are familial pituitary adenomas.

How it is normally diagnosed?
There are different types of pituitary adenomas causing quite varied diseases. Gigantism and its adult counterpart acromegaly is usually diagnosed due to rapid growth, headaches, joint pains, sweating, high blood pressure and visual problems. Pituitary adenomas grow slowly and it usually takes 2-10 years before they get diagnosed. The diagnosis finally is made by blood tests measuring hormones, such as growth hormone, and doing an MRI scan of the pituitary area.

What is the study aiming to find out?
The fact that pituitary adenomas can occur in families relatively commonly was not recognised until recently. Our study introduced testing for gene alterations in the AIP (Aryl Hydrocarbon Receptor Interacting Protein) gene in the UK, and identified until now 38 families with 160 gene carriers via screening. We also aim to identify the disease-causing genes in our other families as well.

How will it benefit patients?
The screening and early treatment of patients can have a huge benefit to patients as earlier treatment will lead to less complications and better chance to recovery. We hope we can stop the abnormal growth spurts therefore avoiding gigantism. Patients that are screened will find out if they carry the AIP gene and whether they are likely to pass on the gene to their families. For most patients, knowing they have a gene abnormality also helps them to understand and accept their condition.

How will it change practice?
As knowledge of the condition becomes more understood, genetic testing of patients to screen for AIP changes should be more commonplace. Patients can be treated knowing they have this condition, and family members who are carriers of the gene can benefit from MRI scans to monitor their pituitary gland and annual hormone tests.

How did the NIHR CRN support the study?
The familial pituitary adenoma study is on the NIHR CRN Portfolio. The study’s association with NIHR has allowed the widespread assessment of the patients, has incentivised referrals from clinicians and raised awareness of both our study and the familial pituitary adenoma condition itself.

For more information contact NIHR CRN Communications Officer, Damian Wilcock on 020 3328 6705  or email


Growth Hormone Deficiency Global Clinical Trials



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