Growth hormone deficiency refers to the insufficient secretion of the growth hormone called somatotropin. Somatotropin deficiency primarily causes delayed growth in children and adolescents, with growth hormone deficiency ranging from mild to severe cases.
What is growth hormone deficiency?
Growth hormone deficiency, also known as hyposomatotropism, is defined by the insufficient production of somatotropin. Also known as STH or GH (growth hormone), this growth hormone is produced in the pituitary gland and is a major contributor to the growth and development of children and adolescents. A deficiency of somatotropin thus leads to delayed, slowed growth. Since this hormone also influences protein and energy balance, the body’s muscle formation and fat breakdown remain restricted by growth hormone deficiency, leading to increased fat deposition, among other things. Similarly, both young and adult affected individuals suffer from low blood sugar levels due to the so-called “insulin-like growth factors” of the missing hormone. However, metabolism and growth can be normalized in growth hormone deficiency by administering somatotropin.
Causes
The causes of growth hormone deficiency, which occurs in about one in 4000 children, are quite varied. For example, somatotropin deficiency occurs either singly or in conjunction with other hormone deficiencies, as the pituitary gland produces various hormones. (In this context, thyroid hormone deficiency or adrenal cortex hypofunction is increasingly apparent). Heredity can also be a reason for somatotropin deficiency (for example, due to genetic structural changes in the hormone or malformations of the secretory cells), as can acquisition through birth complications, shock syndromes, brain tumors, or even injuries to the pituitary gland. If the cause of the growth hormone deficiency cannot be determined, it is called “idiopathic hormone deficiency”. Furthermore, there exists a type of growth hormone deficiency caused by dysfunction of the hypothalamus (an area of the diencephalon), in which somatotropin can be produced but not effectively released by the body.
Symptoms, complaints, and signs
Growth hormone deficiency manifests differently in children and adults. In children, a slowing of general body growth is mainly observed. Thus, only a reduced growth in length takes place in them, but there is no change in body proportions. The most striking features of affected children are small hands and feet, a rounded face with a short nose and small chin, and the development of fat pads on the abdomen. The teeth also develop more slowly. If the growth hormone deficiency occurs later within the growth phase, length growth is only stopped at this point. However, apart from the delay in physical development, children do not experience any other symptoms. Without treatment of growth hormone deficiency, adolescents reach a maximum height of only 1.40 centimeters. Therefore, hormone therapy is necessary until body growth is complete. Secondary growth hormone deficiency in adults causes completely different symptoms. Various diseases, such as a tumor of the pituitary gland (hypophysis), can lead to inhibition of the production or secretion of growth hormones. Typical symptoms include a decrease in muscle mass with a simultaneous increase in fat mass, reduction in bone density (increasing the risk of osteoporosis), listlessness and a drop in blood sugar levels. Sometimes depression also occurs. Treatment of growth hormone deficiency in adults depends on the particular underlying condition.
Diagnosis and course
The main symptom of growth hormone deficiency is slowed growth leading to short stature in adolescents, who usually do not grow taller than about 130 centimeters as adults. Other signs of children suffering from growth hormone deficiency are small hands and feet and a doll-like appearance with only weakly developed muscles and very thin skin. If growth hormone deficiency is suspected, various tests (for example, the arginine or insulin tolerance test) are used.This determines whether it is exclusively a deficiency of somatotropin or whether other hormones are also affected by the underproduction. A proven growth hormone deficiency requires a magnetic resonance imaging examination to determine a possible defect in the pituitary gland.
Complications
Growth hormone deficiency can lead to a number of different symptoms and complications. First and foremost, those affected suffer from impaired growth, with this complaint occurring at a young age. As a result, many children suffer from bullying or teasing and thus also develop psychological complaints or depression. There is very often a short stature and a significant delay in growth. The blood sugar level of the affected person is also relatively low, so that patients often feel tired and cannot easily participate in everyday life. Likewise, a very small penis may result, negatively affecting self-esteem and possibly leading to inferiority complexes. The face also appears childlike itself, with patients often suffering from a delayed onset of puberty. Furthermore, growth hormone deficiency can lead to severe weight gain. As a rule, growth hormone deficiency can be controlled with the help of replacement medication. No particular complications occur. However, those affected are dependent on taking the medication regularly. If the disease is detected at an early stage, many complaints can be alleviated very well. Growth hormone deficiency does not usually have a negative effect on the patient’s life expectancy.
When should you see a doctor?
In the case of growth hormone deficiency, a doctor must always be consulted. This is the only way to prevent further complications and complaints, so a doctor should be consulted at the first signs and symptoms. Early diagnosis of this deficiency has a very positive effect on the further course and also on the further growth of the child. As a rule, there is no independent cure. A doctor should be consulted in the case of growth hormone deficiency if the child suffers from growth problems. This results in very slow growth, which in the worst case can stop completely. The growth problems have a very negative effect on the life of the affected person and can often lead to psychological upsets or depression. A psychologist should also be consulted. A growth hormone deficiency can be detected by a general practitioner, although a pediatrician may also be consulted. Treatment itself is by taking medication and may well relieve symptoms.
Treatment and therapy
In growth hormone deficiency, since somatotropin is not sufficiently available, the hormone called IGF-1 (insulin-like growth factor 1), which contributes significantly to cell division in the cartilage layers and skin, but also to the release of fatty acids, cannot be produced by the organism. In order to nevertheless ensure these functions in the case of an existing growth hormone deficiency, the body must be administered a daily dose of somatotropin. This hormone treatment using genetically engineered somatotropin lasts for years and actually ends when growth is complete. Nevertheless, adults suffering from growth hormone deficiency also require the administration of somatotropin, as the body continues to produce it under normal circumstances, even though the amount decreases with age. Studies have shown that the administered somatotropin, which not only promotes growth but likewise supports metabolism, has a positive effect on the muscle strength, bone density, circulation and vitality of the affected person, which is why continued treatment with somatotropin is effective and useful in the case of growth hormone deficiency even after adolescence. To date, the treatment of growth hormone deficiency has not yet succeeded in producing the active ingredient somatotropin in tablet form or as drops.
Prevention
Prevention of growth hormone deficiency caused by undersupply of somatotropin, as well as its general cure, is not yet possible. However, birth can and should be accomplished by cesarean section in a pregnancy with known breech presentation. This reduces the risk of hypoxia of the brain and thus the risk of growth hormone deficiency.
Aftercare
In most cases, those affected by growth hormone deficiency have few options for direct aftercare. For this reason, they should ideally see a doctor early on and initiate treatment to prevent complications or other medical conditions from developing down the road. The growth hormone deficiency cannot heal itself, so treatment by a doctor is always necessary. Especially the parents of the child should pay attention to the complaints and symptoms and consult a doctor. In most cases, the disease can be cured by taking various medications. It is always important to ensure that the medication is taken regularly and in the correct dosage in order to counteract the symptoms permanently and in the long term. Parents should monitor the correct intake of the medication. If there are any uncertainties or side effects, it is advisable to contact a doctor first. Furthermore, regular medical checks and examinations should be carried out to monitor the current development of the child. The life expectancy of the affected person is usually not reduced or otherwise limited by this disease. Further measures of a follow-up are not necessary in this case.
What you can do yourself
With this diagnosis, it is important to determine what is causing the deficiency. Only then can appropriate therapies be initiated to prevent short stature. However, those affected must undergo the therapy prescribed by their treating physicians on a regular basis – some even for the rest of their lives. However, even if early therapy was able to prevent the short stature, those affected often suffer from depression and/or reduced self-esteem. This is where concomitant psychotherapy sessions should be scheduled. Children and their relatives also benefit from self-help groups. The attending physicians are happy to provide contacts here, but the portal www.einfach-wachsen.de also provides up-to-date information and relevant addresses on the Internet. It is important for those affected to develop a healthy relationship with their bodies, especially since growth hormone deficiency can manifest itself in both children and adults through obesity, poor general well-being and the aforementioned tendency to depression. Sports, especially team sports, can help. It favors the metabolism and also gives the patient the opportunity to playfully measure forces. Since the somatotropin administered daily favors muscle growth, the patient quickly sees success here. The administration of growth hormones can promote diabetes. Patients would therefore do well to counteract this tendency with their diet. They should eat a diet rich in vitamins but low in sugar and fat, and avoid fast food and alcohol.
