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It means that the pituitary gland does not produce enough of this hormone.
Causes
The pituitary gland is located at the base of the brain. This gland controls the balance of hormones in the body. It also produces growth hormone, which makes a child grow.
Growth hormone deficiency may be present at birth. It may be the result of a condition. Severe brain injury can also cause deficiency of this hormone.
Children with physical defects of the face and skull, such as a cleft lip or palate , may have decreased growth hormone levels.
Most of the time, the cause of growth hormone deficiency is unknown.
Symptoms
Slow growth may first be noticed in infancy and continue through childhood. The pediatrician often draws the growth curve of children on a growth chart . Children with growth hormone deficiency have a slow or even growth rate. Slow growth may not be seen until a child is 2 or 3 years old.
The child will be much shorter than most children of the same age and gender. He will have normal body proportions, although the body build may be chubby. Often the child’s face looks younger than other children of the same age. He will also have normal intelligence in most cases.
In older boys, puberty may come late or not at all, depending on the cause.
tests and exams
A physical exam, including weight, height, and body proportions, will show signs of slow growth. The child will not follow normal growth curves.
An x-ray of the hand can determine bone age. Normally, the size and shape of the bones change as a person grows. These changes can be seen on an x-ray and often follow a pattern as a child grows.
Tests are often done after the pediatrician has explored other causes of poor growth. Tests that may be done include:
- Insulin-like growth factor (IGF-1) and insulin-like growth factor-binding protein 3 (IGFBP-3). These are substances produced by the body stimulated by growth hormones. Tests can measure these growth factors. Testing for exact growth hormone deficiency involves a stimulation test , which takes several hours.
- An MRI of the head can show the hypothalamus and pituitary gland.
- Tests may be done to measure other hormone levels, since a lack of growth hormone may not be the only problem.
Treatment
Treatment involves growth hormone injections given at home. These are often applied once a day. Older children can often learn how to give themselves the injection.
Growth hormone treatment is long-term, often lasting several years. During this time, the child should be seen regularly by the pediatrician to ensure that the treatment is working. The provider will change the dose of medicine if needed.
Serious side effects of growth hormone therapy are rare. Common side effects include:
- Headache
- Fluid retention
- Joint and muscle pain
- slipping of the hip bones
Expectations (prognosis)
The sooner the condition is treated, the greater the chance that a child will grow to near normal adult height. Many children grow 4 inches (about 10 centimeters) or more in the first year and 3 inches (about 7.6 centimeters) or more in the next 2 years. Subsequently, the growth rate slowly decreases.
Growth hormone therapy does not work for all children.
Without treatment, growth hormone deficiency can lead to short stature and delayed puberty.
Growth hormone deficiency can occur with deficiencies of other hormones, such as those that control:
- The production of thyroid hormones
- The water balance of the body
- The production of male and female sex hormones
- The adrenal glands and their production of cortisol, DHEA, and other hormones
When to contact a medical professional
Call your provider if your child seems unusually small for his age.
Prevention
Most cases cannot be prevented.
Review your child’s growth chart with the pediatrician at each visit. Likewise, an evaluation by a specialist is advised if there is concern about the child’s growth rate.
Alternative names
pituitary dwarfism; Acquired growth hormone deficiency; Isolated growth hormone deficiency; Congenital growth hormone deficiency; Panhypopituitarism; Short stature – growth hormone deficiency
Images
References
Cooke DW, Divall SA, Radovick S. Normal and aberrant growth in children. In: Melmed S, Auchus RJ, Goldfine AB, Koenig RJ, Rosen CJ, eds. Williams Textbook of Endocrinology . 14th ed. Philadelphia, PA: Elsevier; 2020:chap 25.
Grimberg A, DiVall SA, Polychronakos C, et al. Guidelines for growth hormone and insulin-like growth factor-I treatment in children and adolescents: growth hormone deficiency, idiopathic short stature, and primary insulin-like growth factor-I deficiency. Horm Res Paediatr . 2016;86(6):361-397. PMID: 27884013www.ncbi.nlm.nih.gov/pubmed/27884013.
Patterson BC, Felner EI. Hypopituitarism. In: Kliegman RM, St. Geme JW, Blum NJ, Shah SS, Tasker RC, Wilson KM, eds. Nelson Textbook of Pediatrics . 21st ed. Philadelphia, PA: Elsevier; 2020:chap 573.
