What is growth hormone deficiency in children?

Growth hormone (GH) deficiency is when the pituitary gland doesn't make enough growth hormone. GH is needed to stimulate growth of bone and other tissues. This condition can occur at any age. It does not affect a child's intelligence or other part of the child's brain.

What causes GH deficiency in a child?

The pituitary gland is a pea-sized gland located at the base of the brain. It’s the master endocrine gland in the body. The pituitary gland normally releases several different hormones. These hormones control growth, metabolism, blood pressure, and other body processes.

GH deficiency can be caused by damage to the pituitary or hypothalamus gland. The injury can occur before birth (congenital), or during or after birth (acquired).

In rare cases, GH deficiency can be part of a genetic syndrome. In many cases, the cause of GH deficiency is not known (idiopathic).

Which children are at risk for GH deficiency?

A child is more at risk for GH deficiency if they have:

• A brain injury.

• A brain tumor.

• Radiation treatment to the head.

• Genetic leaning.

Some children with the problem have none of the risk factors.

What are the symptoms of GH deficiency in a child?

The main sign of GH deficiency is slower height growth than expected each year. This means a yearly growth in height of less than about 2.2 inches (5.5 cm) between ages 2 and 4, and less than about 2 inches (5 cm) between ages 4 and 6. It's a yearly growth of less than 1.6 inches (4 cm) for boys and less than 1.8 inches (4.5 cm) for girls between age 6 and the onset of puberty. A child with GH deficiency may also have:

• A younger-looking face.

• A chubby body build.

• Impaired hair growth.

• Delayed puberty.

• Delayed tooth development.

It's important to note that GH deficiency does not affect the child's intelligence.

The symptoms of GH deficiency can be like other health conditions. Make sure your child sees their health care provider for a diagnosis.

How is GH deficiency diagnosed in a child?

To diagnose GH deficiency, your child’s provider needs to check for other conditions, such as:

• Normal variations of growth, such as familial short stature.

• Other disorders, such as thyroid hormone deficiency or kidney disease.

• Genetic conditions, such as Laron syndrome where patients lack receptors for growth hormone.

The provider will ask about your child’s symptoms and health history and about your family’s health history. They will also give your child a physical exam. Your child's health and growth may be checked over several months.

Your child may also have tests, such as:

• Blood tests. These are done to check growth hormone and other related growth factors. They are also done to rule out other conditions.

• GH stimulation test. Medicines are given to stimulate the pituitary to release GH. If levels in the blood do not rise to a certain level over a period of time, it may mean the pituitary is not making enough hormone.

• X-ray. This test uses a small amount of radiation to make images of tissues inside the body. An X-ray may be done of the left hand and wrist. This can estimate your child's bone age. With delayed puberty or hormone problems, bone age is often less than calendar age.

• CT scan. This test uses a series of X-rays and a computer to make detailed images of the body. A CT scan can show bones, muscles, fat, and organs. CT scans are more detailed than regular X-rays.

• MRI scan. This test uses large magnets and a computer to make detailed images of tissues in the body without using X-rays.

How is GH deficiency treated in a child?

Your child's provider will consider your child's age, overall health, and other factors when advising treatment. Your child may need to see a pediatric endocrinologist. This is a provider with extra training in treating children with hormone problems. This specialist will also have the best equipment to accurately measure your child's growth from month to month.

Treatment may involve daily injections of synthetic growth hormone. Results are often seen as soon as 3 to 4 months after treatment starts. The treatment lasts several years, usually until late puberty when growing is finished. The earlier the treatment is started, the better the chances that a child will have a normal or near-normal adult height that matches their family pattern. A once-weekly growth hormone preparation recently became available.

Not all children respond well to growth hormone treatment. GH therapy does not make a person taller than their parents. The burden of daily growth hormone injections for 10 years or more may have its own gative psychological impact on the child. Your child may have other treatments depending on what causes the deficiency.

What are possible complications of GH deficiency in a child?

If untreated, GH deficiency can cause a child to not reach their normal adult height.

How can I help my child live with GH deficiency?

Children who are shorter than their peers may have poor self-esteem or depression. It’s important to talk about these problems with your child and your child's provider. The provider can recommend counseling or support groups for you and your child.

Talk with your child's provider about your child's potential adult height. Work with your child's providers to create an ongoing plan to manage your child’s condition.

When should I contact my child's doctor?

Talk with your child’s provider if you are concerned about your child's growth.

Key points about GH deficiency in children

• Growth hormone (GH) deficiency is when the pituitary gland doesn't make enough growth hormone. GH is needed to stimulate growth of bone and other tissues.

• GH deficiency does not affect a child's intelligence.

• The main sign of GH deficiency is slowed height growth each year than expected. A child with GH deficiency may also have a younger-looking face and a chubby body build.

• Treatment may include daily or weekly injections of synthetic growth hormone. Results are often seen as soon as 3 to 4 months after treatment starts. The treatment lasts several years, usually until late puberty when growing is finished.

• The earlier the treatment is started, the better the chances that a child will have a normal or near-normal adult height that matches their family pattern.

• If untreated, GH deficiency can cause a child to not reach their normal adult height.

Next steps

Tips to help you get the most from a visit to your child’s provider:

• Know the reason for the visit and what you want to happen.

• Before your visit, write down questions you want answered.

• At the visit, write down the name of a new diagnosis and any new medicines, treatments, or tests. Also write down any new instructions your provider gives you for your child.

• Know why a new medicine or treatment is prescribed and how it will help your child. Also know what the side effects are and when they should be reported.

• Ask if your child’s condition can be treated in other ways.

• Know why a test or procedure is recommended and what the results could mean.

• Know what to expect if your child does not take the medicine or have the test or procedure.

• If your child has a follow-up appointment, write down the date, time, and purpose for that visit.

• Know how you can contact your child’s provider after office hours or on weekends. This is important if your child becomes ill and you have questions or need advice.