Growth Hormone Replacement Therapy – Effects & Use
Growth hormone replacement therapy (GHRT) replaces deficient growth hormone in children and adults. It is used to treat growth hormone deficiency and improves metabolism, body composition, and quality of life.
Things worth knowing about "Growth Hormone Replacement Therapy"
Growth hormone replacement therapy (GHRT) replaces deficient growth hormone in children and adults. It is used to treat growth hormone deficiency and improves metabolism, body composition, and quality of life.
What is Growth Hormone Replacement Therapy?
Growth hormone replacement therapy (GHRT) is a medical treatment in which a biosynthetic form of growth hormone (somatropin) is administered to compensate for a deficiency in the body. Growth hormone is normally produced by the pituitary gland, a small gland at the base of the brain, and plays a key role in regulating growth, metabolism, and body composition.
When a growth hormone deficiency (GHD) is confirmed, this therapy can be used in both children and adults to replace the missing hormone and address the associated health complications.
Causes of Growth Hormone Deficiency
Growth hormone deficiency can result from various causes:
- Congenital causes: Genetic mutations or structural malformations of the pituitary gland or hypothalamus
- Acquired causes: Pituitary tumors (e.g., craniopharyngioma), radiation therapy or surgery in the head or brain region
- Idiopathic deficiency: Growth hormone deficiency without an identifiable cause, commonly seen in children
- Traumatic brain injury: Head trauma can impair pituitary function
- Inflammatory conditions: Autoimmune diseases or infections affecting the pituitary gland
Indications
Growth hormone replacement therapy is approved for the following groups:
- Children with growth hormone deficiency: To promote height growth and normal physical development
- Children with Turner syndrome: A chromosomal condition associated with short stature
- Children with Prader-Willi syndrome: A genetic condition causing growth disorders
- Children born small for gestational age (SGA): When catch-up growth does not occur adequately
- Adults with growth hormone deficiency: Due to pituitary insufficiency following tumors, surgery, or radiation
- Children with chronic renal insufficiency: When kidney disease causes growth retardation
Mechanism of Action
The somatropin used in therapy is a recombinant human growth hormone that is structurally identical to the body's own growth hormone. It binds to specific receptors in the liver, muscle, adipose tissue, and bones, triggering the following effects:
- Stimulation of the liver to produce IGF-1 (Insulin-like Growth Factor 1), the primary mediator of growth effects
- Promotion of height increase through activation of growth plates (epiphyseal plates) in children
- Improvement of body composition: reduction of body fat, increase of lean muscle mass
- Positive effects on bone metabolism and mineral density
- Improvement of lipid profile (cholesterol and triglyceride levels)
- Support of cardiac function and the cardiovascular system
How the Therapy is Administered
Somatropin is typically administered as a daily subcutaneous injection (under the skin), preferably in the evening, as the body's natural growth hormone secretion peaks during nighttime sleep. Modern injection devices (pens) make administration straightforward, enabling patients to self-administer at home.
The dosage is individually adjusted based on age, body weight, indication, and response to treatment. Regular follow-up appointments with an endocrinologist are essential to monitor the therapy and make adjustments as needed.
Side Effects
Growth hormone replacement therapy is generally well tolerated when correctly dosed. Possible side effects include:
- Fluid retention (edema), especially at the beginning of treatment
- Joint pain (arthralgia) and muscle pain (myalgia)
- Headaches
- Numbness or tingling in the extremities (carpal tunnel syndrome possible)
- Elevated blood glucose levels (insulin resistance); rarely, development of diabetes mellitus
- Injection site reactions (redness, swelling)
- In children: possible increased risk of scoliosis and slipped capital femoral epiphysis
Contraindications
The therapy must not be used in the following situations:
- Active malignancies (cancer)
- Acute critical illness (e.g., following major surgery or severe trauma)
- Uncontrolled diabetic retinopathy
- Known hypersensitivity to somatropin
- Closed epiphyses (for certain pediatric indications)
Duration of Therapy
In children, therapy is generally continued until growth is complete (closure of growth plates). In adults with pituitary growth hormone deficiency, therapy may be required lifelong, provided the deficiency persists and the indication is regularly reassessed by a specialist.
References
- Molitch ME et al. - Evaluation and Treatment of Adult Growth Hormone Deficiency: An Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab. 2011; 96(6):1587-1609.
- GH Research Society - Consensus Guidelines for the Diagnosis and Treatment of Growth Hormone (GH) Deficiency in Childhood and Adolescence. J Clin Endocrinol Metab. 2000; 85(11):3990-3993.
- Cook DM et al. - American Association of Clinical Endocrinologists Medical Guidelines for Clinical Practice for Growth Hormone Use in Growth Hormone-Deficient Adults and Transition Patients. Endocr Pract. 2009; 15(Suppl 2):1-29.
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