Growth hormoneGHD can be present at birth or develop later in life. Treatment is by growth hormone replacement. Severe prenatal deficiency of GH, as occurs in congenital hypopituitarismhas little effect on fetal growth. However, prenatal and congenital deficiency can reduce the size of a male's penisespecially when gonadotropins are also human growth hormone injections wikipedia. Besides micropenis in males, additional equipois x ar of severe deficiency in the first days of life can include hypoglycemia and exaggerated jaundice both direct and indirect hyperbilirubinemia.
Growth hormone deficiency - Wikipedia
GHD can be present at birth or develop later in life. Treatment is by growth hormone replacement. Severe prenatal deficiency of GH, as occurs in congenital hypopituitarism , has little effect on fetal growth. However, prenatal and congenital deficiency can reduce the size of a male's penis , especially when gonadotropins are also deficient.
Besides micropenis in males, additional consequences of severe deficiency in the first days of life can include hypoglycemia and exaggerated jaundice both direct and indirect hyperbilirubinemia. Even congenital GH deficiency does not usually impair length growth until after the first few months of life. Growth is not as severely affected in GH deficiency as in untreated hypothyroidism , but growth at about half the usual velocity for age is typical.
It tends to be accompanied by delayed physical maturation so that bone maturation and puberty may be several years delayed. Severe GH deficiency in early childhood also results in slower muscular development, so that gross motor milestones such as standing, walking, and jumping may be delayed.
Some severely GH-deficient children have recognizable, cherubic facial features characterized by maxillary hypoplasia and forehead prominence said to resemble a kewpie doll. Other side effects in children include sparse hair growth and frontal recession, and pili torti and trichorrhexis nodosa are also sometimes present. Growth hormone deficiency in childhood commonly has no identifiable cause idiopathic , and adult-onset GHD is commonly due to pituitary tumours and their treatment or to cranial irradiation.
There are a variety of rare diseases which resemble GH deficiency, including the childhood growth failure, facial appearance, delayed bone age, and low IGF levels. However, GH testing elicits normal or high levels of GH in the blood, demonstrating that the problem is not due to a deficiency of GH but rather to a reduced sensitivity to its action.
Insensitivity to GH is traditionally termed Laron dwarfism , but over the last 15 years many different types of GH resistance have been identified, primarily involving mutations of the GH binding protein or receptors. As an adult ages, it is normal for the pituitary to produce diminishing amounts of GH and many other hormones, particularly the sex steroids. Physicians therefore distinguish between the natural reduction in GH levels which comes with age, and the much lower levels of "true" deficiency.
Such deficiency almost always has an identifiable cause, with adult-onset GHD without a definable cause "idiopathic GH deficiency" extremely rare.
Although GH can be readily measured in a blood sample, testing for GH deficiency is constrained by the fact that levels are nearly undetectable for most of the day. This makes simple measurement of GH in a single blood sample useless for detecting deficiency. Physicians therefore use a combination of indirect and direct criteria in assessing GHD, including:.
An intravenous line is established, the agent is given, and small amounts of blood are drawn at 15 minute intervals over the next hour to determine if a rise of GH was provoked. Agents which have been used clinically to stimulate and assess GH secretion are arginine ,  levodopa , clonidine , epinephrine and propranolol , glucagon and insulin.
An insulin tolerance test has been shown to be reproducible, age-independent, and able to distinguish between GHD and normal adults,  and so is the test of choice. In childhood and adulthood, the diagnosing doctor will look for these features accompanied by corroboratory evidence of hypopituitarism such as deficiency of other pituitary hormones, a structurally abnormal pituitary, or a history of damage to the pituitary.
This would confirm the diagnosis; in the absence of pituitary pathology, further testing would be required. Growth hormone deficiency can be congenital or acquired in childhood or adult life. It can be partial or complete. It is usually permanent, but sometimes transient. It may be an isolated deficiency or occur in association with deficiencies of other pituitary hormones. The term hypopituitarism is often used interchangeably with GH deficiency but more often denotes GH deficiency plus deficiency of at least one other anterior pituitary hormone.
When GH deficiency usually with other anterior pituitary deficiencies is associated with posterior pituitary hormone deficiency usually diabetes insipidus , the condition is termed panhypopituitarism.
GH deficiency is treated by replacing GH with daily injections under the skin or into muscle. Until , growth hormone for treatment was obtained by extraction from human pituitary glands collected at autopsy. Since , recombinant human growth hormone rHGH is a recombinant form of human GH produced by genetically engineered bacteria , manufactured by recombinant DNA technology. In both children and adults, costs of treatment in terms of money, effort, and the impact on day-to-day life, are substantial.
GH treatment is not recommended for children who are not growing despite having normal levels of growth hormone, and in the UK it is not licensed for this use. Most pediatric endocrinologists monitor growth and adjust dose every 3—6 months and many of these visits involve blood tests and x-rays. Treatment is usually extended as long as the child is growing, and lifelong continuation may be recommended for those most severely deficient.
Nearly painless insulin syringes , pen injectors , or a needle-free delivery system reduce the discomfort. Injection sites include the biceps, thigh, buttocks, and stomach. Injection sites should be rotated daily to avoid lipoatrophy.
Lower doses again are called for in the elderly to reduce the incidence of side effects and maintain age-dependent normal levels of IGF In many countries, including the UK, the majority view among endocrinologists is that the failure of treatment to provide any demonstrable, measurable benefits in terms of outcomes means treatment is not recommended for all adults with severe GHD,  and national guidelines in the UK as set out by NICE suggest three criteria which all need to be met for treatment to be indicated:.
When treated with GH, a severely deficient child will begin to grow faster within months. In the first year of treatment, the rate of growth may increase from half as fast as other children are growing to twice as fast e. Growth typically slows in subsequent years, but usually remains above normal so that over several years a child who had fallen far behind in his height may grow into the normal height range.
Excess adipose tissue may be reduced. GH treatment can confer a number of measurable benefits to severely GH-deficient adults, such as enhanced energy and strength, and improved bone density.
Muscle mass may increase at the expense of adipose tissue. Although adults with hypopituitarism have been shown to have a reduced life expectancy, and a cardiovascular mortality rate more than double controls,  treatment has not been shown to improve mortality, although blood lipid levels do improve.
Similarly, although measurements of bone density improve with treatment, rates of fractures have not been shown to improve. Effects on quality of life are unproven, with a number of studies finding that adults with GHD had near-normal indicators of QoL at baseline giving little scope for improvement , and many using outdated dosing strategies. However, it may be that those adults with poor QoL at the start of treatment do benefit. The incidence of idiopathic GHD in infants is about 1 in every live births,  and rates in older children are rising as more children survive childhood cancers which are treated with radiotherapy, although exact rates are hard to obtain.
The incidence of genuine adult-onset GHD, normally due to pituitary tumours, is estimated at 10 per million. Like many other 19th century medical terms which lost precise meaning as they gained wider currency, " midget " as a term for someone with severe proportional shortness acquired pejorative connotations and is no longer used in a medical context.
Notable modern pop cultural figures with growth hormone deficiency include actor and comedian Andy Milonakis , who has the appearance and voice of an adolescent boy despite being in his early 40s. From Wikipedia, the free encyclopedia. Growth hormone deficiency Synonyms Pituitary dwarfism Growth hormone Specialty Endocrinology Symptoms Short height  Complications Low blood sugar , high cholesterol levels , poor bone density   Types Congenital , acquired  Causes Not enough growth hormone  Risk factors Genetics , trauma, infections, tumors , radiation therapy  Diagnostic method Blood tests for growth hormone  Differential diagnosis Small for gestational age , Turner syndrome , Noonan syndrome , Prader-Willi syndrome  Treatment Growth hormone replacement  Frequency Unclear  Growth hormone deficiency GHD is a medical condition due to not enough growth hormone GH.
Retrieved 12 December Retrieved 13 December Andrews' Diseases of the Skin: Retrieved 20 January National Institute for Clinical Excellence.
Archived from the original pdf on The Society for Endocrinology. UK Child Growth Foundation. Diseases of the endocrine system E00—E35 , — Hypoglycemia beta cell Hyperinsulinism G cell Zollinger—Ellison syndrome.
Iodine deficiency Cretinism Congenital hypothyroidism Myxedema Euthyroid sick syndrome. Hyperthyroxinemia Thyroid hormone resistance Familial dysalbuminemic hyperthyroxinemia Hashitoxicosis Thyrotoxicosis factitia Graves' disease. Endemic goitre Toxic nodular goitre Toxic multinodular goiter Thyroid nodule.
Primary Secondary Tertiary Osteitis fibrosa cystica. Cushing's syndrome Pseudo-Cushing's syndrome sex hormones: Polycystic ovary syndrome Premature ovarian failure testicular: Hypogonadism Delayed puberty Hypergonadism Precocious puberty Hypoandrogenism Hypoestrogenism Hyperandrogenism Hyperestrogenism Postorgasmic illness syndrome.
Congenital , acquired . Not enough growth hormone . Genetics , trauma, infections, tumors , radiation therapy .
Blood tests for growth hormone . Small for gestational age , Turner syndrome , Noonan syndrome , Prader-Willi syndrome . Growth hormone replacement . Hypofunction Diabetes mellitus types: Hypothalamus gonadotropin Kallmann syndrome Adiposogenital dystrophy CRH Tertiary adrenal insufficiency vasopressin Neurogenic diabetes insipidus general Hypothalamic hamartoma. Hypothyroidism Iodine deficiency Cretinism Congenital hypothyroidism Myxedema Euthyroid sick syndrome.