Growth hormone deficiency, GHD
• Disease overview
• Clinical manifestations, causes
• Auxiliary inspection and diagnosis
• Treatment and prognosis
The secretion pattern of growth hormone under physiological conditions:
Growth hormone challenge test:
Growth medium determination: (IGF-I) and IGFBP3
Growth hormone releasing hormone (GHRH) challenge test: differential diagnosis of hypothalamic and pituitary causes of GHD
Thyroid function test: exclusion of hypothyroidism
Chromosome: Females exclude Turner syndrome
Imaging examination: bone age, shape of the saddle, presence or absence of calcification, pituitary morphology, size, exclusion of tumor
Selection assay: blood ACTH, cortisol, blood sugar, sex hormones to exclude other pituitary hormone deficiency
Diagnose based on:
• Short, height < -2SD
• The bone age is less than 2 years of actual age
• Annual height growth rate <5cm
• GH peak < 10 ug/L • MRI shows the reduction of the anterior pituitary • Some children may be accompanied by diabetes insipidus or hypothyroidism Differential diagnosis Treatment (1) Recombinant human growth hormone injection Recombinant Human Growth Hormone for Injection Specification: 30IU/PC Indications: Child growth hormone deficiency, Turner’s syndrome, growth disorders caused by chronic renal insufficiency in children, surgery, post-traumatic hypermetabolism (negative nitrogen balance), burns, sepsis sepsis. Dosage: The dosage used to promote child growth varies from person to person. The recommended dose is 0.10-15 IU/kg body weight/day, and 3 months is a course of treatment. method: 1hr subcutaneous injection before bedtime (thigh, upper arm or umbilical circumference) Treatment (1) Recombinant human growth hormone injection Adverse reactions: Local reaction: red, swollen, itchy skin Hypothyroid hormone (T4) Sodium sulphate retention, intracranial hypertension Very few femoral skulls, spondylolisthesis, joint pain, etc. Produce antibodies (antibody binding effect > 2mg / L affects efficacy)
Regular review of thyroid function after treatment
It should not be used after the injection has been frozen. The powder injection is now ready for use.
Blood glucose >10mmol/L, insulin is required. If the dosage of insulin exceeds 150IU/day, the drug should be discontinued.
(1) Recombinant human growth hormone injection
1, leukemia, intracranial tumors, etc. with caution or disabled
2, diabetic patients, impaired glucose tolerance
3, systemic serious infection and acute shock period
1, combined with glucocorticoids, its growth-promoting efficacy can be inhibited, the amount of glucocorticoid should be 2, combined with anabolic hormones and sex hormones, can accelerate the early closure of the epiphysis.
(two) thyroid hormone drugs
Thyroid hormone promotes catabolism and anabolism
Dosage: Complete replacement: Start with a one-third to one-half of the total replacement, and gradually increase every two weeks.
Note: Patients with hypopituitarism or adrenal insufficiency should use adrenal cortex hormones for several days before administration of levothyroxine sodium.
(C) anabolic hormones and sex hormones
Enhance the synthesis of protein in the body, play a role in promoting growth, but accelerate the effect of osteophyte fusion, only when the bone age is behind the actual age of 3 years old.
• Nandrolone phenylpropionate: 1mg/kg/time, IM, BIW, after 10 injections, the drug is stopped for half a year, and the bone age is reviewed. One year is a course of treatment.
• Combined with estrogen: From 310ug/day, gradually increase the dose according to clinical effects.
• Testosterone enanthate: intramuscular injection: 5 mg each time after 11 years or 12 years, once every 3 weeks, 50 mg every 6 to 9 months until an adult dose of 200 mg is reached.
• 1. It is currently considered difficult to treat this disease, but early treatment is better.
• 2. Drug treatment is mainly hormone therapy and supplementation of trace elements.
• 3. Psychotherapy and diet therapy are also important measures for the treatment of this disease.