Growth Hormone, produced by the pituitary gland, determines how tall or short we are falling in our growing years. SHAlINI SAKSENA finds out that this hormone which we take for granted, has been facing a serious disorder of late
Growth hormone (GH), a type of protein, normally produced by the pituitary gland is situated in the brain. GH is needed for normal growth and development in children. GH also helps in maintaining appropriate balance of glucose, fat and cholesterol levels in blood and helps in building and maintaining muscles, bones and decreases fat mass that are required for normal healthy lifestyle.
Talking about the symptoms of GHD, Dr IPS Kochar, senior paediatric and adolescent endocrinologist & diabetologist says: “Any decrease or a complete lack of production of GH is termed as growth hormone deficiency (GHD). The GHD in children usually manifests as short stature and decreased growth rate in comparison to other children of same age and gender. Further children may appear overweight to obese, with deranged blood glucose, and cholesterol levels. Decreased school performance, behaviour problems, and reduced social competency were observed in children who were short.”
Globally, the number of new children affected with GHD every year is estimated to range between one in 3,500 to 10,000 live births.
A child’s growth pattern is an important part of determining normal growth. The child may grow normally until he or she is about two to three years old; then, signs of growth delay begins to show. Other symptoms may include an immature face, he may look younger than his peers; and absent or delayed sexual development, no change in size of shoe over last two years, shortest in class.
The GHD children may have a prominent skull, and are often overweight for their age. In severe GH deficiency in children who are affected since birth there might be a delay in achieving milestones such as standing, walking, and jumping etc.
As short height or delay in height gain is the main manifestation of GHD, it is very critical and important to observe child’s growth pattern using a growth chart for early detection of delay in growth. Growth chart is a graph that can be used to plot vital measurements such as child’s height and weight from birth. On periodic assessments (once in six months or a year), it is possible to detect the child’s growth pattern and compare it to the growth pattern of the normal children of same age and gender. GHD or similar other growth disorders should be suspected in any child (4 years of age) who grows less than 4-5 cm every year.
The good thing is that GHD is treatable. “Once GHD is diagnosed and confirmed, treatment with Growth Hormone can be initiated. Growth hormone therapy is recommended as a subcutaneous injection, either daily or several times per week, but one should always consult the doctor. Success to GH therapy is monitored by the ability to gain the height velocity and the ability to reach a normal adult height or achieve nearly their full growth potential. It is critical to abide by the doctor’s instructions to regularly adhere to GH injections without missing any dose to achieve the desired results,” Dr Kocher tells you.
According to Dr Saket Kant, senior consultant, Endocrinologist at Sri Balaji Action Medical Institute, the prevalence of growth disorders in Indian children is to the tune of five to 10 per cent and that there are tests to detect growth disorders.
“The tests for evaluation depend on the clinical setting and are hence different for every child who is assessed. However, not all parents need to for these tests for their ward. The best way is to maintain a growth chart for children and do frequent plots for height and weight on the charts. Any deviation from the normal growth curve should prompt an evaluation by the treating doctor. A comparison of growth with children of the same age (classmates, cousins) can also guide about which child has to be evaluated,” Dr Kant tells you and warns you against taking some of the wonder pills in the market that promise height gain.
“The height gain pills available in the market are marketed as wonder pills to increase height in all causes of short stature which is not true. All children with short stature have to be evaluated individually and treated according to the defect/deficiency that is found. There is no one size fits all for children with growth failure. The contents of these pills are not known and in fact many of these pills can do more harm than good,” Dr Kant says.
Causes
malnutrition, systemic diseases, anemia, skeletal (bone) disorders, familial short stature (short parents), endocrine disorders like hypothyroidism, growth hormone deficiency, combined pituitary hormone disorders, increased cortisol levels; intrauterine growth retardation, chromosomal and other disorders.
Treatment
Initiation with growth hormone therapy at early age (between 4 – 6 years of age) has maximal benefit than starting later or after 10 -12 years of age. GH injections are recommended till the growing ends of the bone fuse that results in cessation of further growth. Any child diagnosed with GHD after the age of 12-14 years may not derive benefit of GH treatment because the growing ends of bone fuse even before the start of GH treatment. Hence early diagnosis is extremely important for timely initiation of treatment to achieve good results.