Growth Hormone Deficiency in Child – Causes, Symptoms, and Treatment

The brain’s pituitary gland produces the growth hormone, which controls and regulates many functions in the body and determines growth levels. Growth Hormone Deficiency of GHD is a condition when the pituitary glands do not produce enough of the growth hormone required for normal growth.

The growth hormones in one’s body build up during childhood, reach the top at puberty and start to decline after their 30s. They help stimulate the growth of the bone and other tissues in the body. The condition can occur at any stage and does not have any bearing on a child’s intelligence. It could also be caused due to damage to the pituitary gland or the hypothalamus. The injury could be congenital (before birth) or acquired (after birth).

The pituitary gland is the master endocrine gland of the size of a pea located at the base of the brain. The pituitary gland releases eight hormones that regulate metabolism, blood pressure, growth, and other body processes. In some cases, Growth Hormone Deficiency could be a part of the genetic syndrome, and in several cases, the cause of GHD is unknown.

What Is Growth Hormone Deficiency in Kids?

When the release by the pituitary gland of the growth hormone is low, growth hormone deficiency occurs in kids and stagnates growth. It results in evidently short stature in children. It could be partial (where not enough hormone is released) or total (where no amount of hormone is released). About one in 4000-10000 children are diagnosed with growth hormone deficiency. Many of these children could reach a normal, average height when detected and treated early. Growth rates differ in children, but on average, “normal” growth is categorized as below:

• 0-12 Months: about 10 inches annually
• 1-2 Years: about 5 inches annually
• 2-3 Years: about 3.5 inches annually
• 3-15 Years: about 2-2.5 inches annually

If your child is lower than the third percentile in their age group, there could be a chance of GHD.

What Causes Growth Hormone Deficiency? 

Dwarfism growth hormone deficiency can occur due to damage in the pituitary gland or hypothalamus that could have occurred at birth or after. The causes can be classified into two categories:

1. Congenital GHD Reasons 

Congenital growth hormone deficiency occurs where there are mutations or alterations in genes vital for the development of the pituitary gland. They could also occur when there are mutations in the receptors and factors in the growth hormone pathway. No certain cause for this has been known until date. Some congenital causes are:

• Turner Syndrome: Often occurring in females, it occurs when one is born without the X chromosome. It is characterized by short stature and growth retardation in the uterus. Growth retardation is due to the body’s inability to make use of the growth hormone produced.
• Prader-Willi Syndrome is caused by a lack of a parental/original copy of the gene in chromosome 15 and is displayed by poor sucking and feeding issues in infancy and decreased muscle tone. Children display developmental delays and morbid obesity if a healthy diet is not followed.
• Small For Gestational Age: Kids born small for gestational age experience retardation in growth in adulthood too. It occurs due to abnormal secretion of growth and abnormal insulin levels.
• Primary Growth Hormone Insensitivity is also called Laron syndrome. The body cannot use the growth hormone in this condition.

2. Acquired GHD Reasons

The acquired causes for growth hormone deficiency are:

• A brain tumor in the pituitary gland or hypothalamus
• Trauma to the head
• Radiation therapies to treat cancer, especially if the treatment field includes the hypothalamus and the pituitary gland.
• Diseases that affect the hypothalamus or the connection to the pituitary gland, such as histiocytosis
• Lymphocytic hypophysitis is an autoimmune condition

It is important to know that growth hormone deficiency is one of the many factors affecting a child’s growth. The short stature, which is the primary physical attribute of growth hormone deficiency, could be because of many reasons- lack of nutritional intake, hypothyroidism or increased metabolism, or gastrointestinal disorders.

Symptoms of Growth Hormone Deficiency

Growth Hormone Deficiency is characterized by high or low levels of moving growth hormone, late bone age, delayed puberty, protruding forehead, and low blood sugar levels. Some common growth hormone deficiency signs are:

• Slow or stunted growth after the age of three
• Young looking face
• Stout and chubby build of the body
• Prominent forehead
• Slightly flawed development of the bridge of the nose
• Delayed puberty

As these symptoms could occur in other medical conditions, too, it is recommended to consult a physician for any diagnosis.

Possible Complications and Side Effects 

Children of families with existing genetic disorders, children who have suffered a brain injury or tumor, or those going through radiation therapy are at a higher risk of developing growth hormone deficiency. It can result in some side effects and complications as below:

• Lowered bone mineral density
• Increase risk of cardiovascular problems
• Low energy levels

Growth Hormone Deficiency Treatment in Children

A growth increment is one of the primary indicators of the presence of growth hormone deficiency. The chart below explains the normal growth rate in children.

• 1-6 Months: 16-17 cm
• 7-12 Months: 8 cm
• 1-2 Years: 10 cm or more
• 2-3 Years: 8 cm or more
• 3-4 Years: 7 cm
• 4-10 Years: 5-6 cm

A decrease in the growth rate by 10% could point towards a deficiency in growth velocity. Once a referral is made to a doctor, the family’s medical history could be asked for. The doctor may also recommend the following tests:

• Blood Tests: Growth Hormone levels increase and decrease in short bursts, so no one test could diagnose when the bursts occur. Doctors look at levels of two proteins that are generally table and key indicators of growth hormone function: 

1. IGF-1, or insulin-like growth factor I
2. GFPB-3, or insulin-like growth factor binding protein

• X-Rays for Bone Age: X-rays of the child’s hands and wrists help diagnose a sign of growth hormone deficiency.
• Simulation Test for Growth Hormone: This is a follow-up test when other tests indicate a deficiency. The child will have to fast overnight or for a certain number of hours. Doctors administer medicine that will make the body produce a burst of growth hormone. Blood tests will then be conducted to check the levels at the peak. Low levels indicate deficiency.
• MRI of the Brain: This indicated the picture of the brain and any issues with the pituitary gland.

How to Treat Growth Hormone Deficiency in Children? 

Since the middle of the ’80s, synthetic growth hormones have been used to treat growth hormone deficiency in children and adults. Before this, natural growth hormones from cadavers were used for treatment.

It is administered subcutaneously by injections into fatty tissues of the body, especially in places like the back of thighs, arms, or buttocks. It is most effective when administered daily. An endocrinologist will give you the course of the treatment. At each visit, the doctor will monitor the following:

• Growth of the child
• Blood tests on child’s response to medicine
• Change of dose if needed.

Side Effects Are Rare and Could Include:

• Soreness or redness at the injection site
• Headache
• Pain in hip
• Scoliosis or curvature of the spine
• In rare cases, long-term effects could include the development of diabetes, especially if there is a family history.

Treatment lasts until growth is completed, mostly in the late teens.

How to Help a Child With Growth Hormone Deficiency?

Along with doctor’s treatment, there are other ways to help your child with the deficiency:

• Regular exercise, especially aerobics, is said to aid in growth hormone production and reduce fat.
• Growth hormone therapy temporarily increases sugar levels in the body. A strict regime and control of the intake of carbohydrates and sugar supplemented by nutritious food could help.
• Adequate sleep is also vital for producing growth hormones, and a strict bedtime routine would help with this.
• Follow instructions by the doctor very carefully when undergoing the treatment.
• Make sure to keep everyone concerned, like the pediatrician and another medical professional, about the treatment.
• Be on top of check-up routines and do not miss any appointments.
• Seek counseling if your child seems to suffer from low self-esteem, grief, or bullying from peers.

How Can the Treatment Help? 

One of the key signs of the treatment will be noticeable growth. It could take anywhere between three to six months to notice any visible signs. The child may grow by one or two inches within the first lap or six months of treatment. One could also notice

• Growth in foot size within 6-8 weeks, and your child’s feet will outgrow their shoes.
• Increased appetite.
• An increase in lean body mass can be noticed, and the child may appear slimmer with the growth hormone treatment.

The growth hormone deficiency treatment in children is long-term and could continue until the child reaches complete growth potential. It is important to visit the endocrinologist regularly and monitor growth through blood tests and X-rays. It is mandatory to keep up with the follow-up schedule of the treatment, and treatment may vary from child to child.

Children with congenital growth hormone deficiency could be treated with growth hormones until puberty. Some children with little growth hormone in their youth will begin to produce more as they enter adulthood. On the contrary, some may retain treatment for their entire lives. The doctor may determine the length of the treatment and need for injection by conducting mandatory blood tests and checking hormone levels in the blood.

As a parent, it is important to monitor your child’s growth as per their developmental milestones and average “growth rates.” If there is any doubt, a doctor must be consulted. It could be just a delay or any other medical condition. However, it is only a doctor who can confirm if there a growth hormone deficiency exists. The sooner the treatment is started, the sooner the child responds. Most children respond well to the treatment. If your child is not meeting the normal height and weight standard, it is advisable to check if they have a growth hormone deficiency. Early diagnosis speeds recovery, and if left untreated, it could result in a lesser than average height. The body needs growth hormone after puberty, and in adulthood, the hormone maintains the body’s structure and metabolism rate.

Also Read:

Balanitis in Children
Vitamin D Deficiency in Kids
Factors that Affect Growth and Development in Children