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Growth hormone deficiency - children

Growth hormone deficiency means the pituitary gland does not make enough growth hormone.

Alternative Names

Pituitary dwarfism; Acquired growth hormone deficiency; Isolated growth hormone deficiency; Congenital growth hormone deficiency; Panhypopituitarism

Causes

The pituitary gland is located at the base of the brain. This gland controls the body’s balance of hormones. It also makes growth hormone. This hormone causes a child to grow.

Growth hormone deficiency may be present at birth (congenital). Or it may be the result of medical condition. Severe brain injury may also cause growth hormone deficiency.

Children with physical defects of the face and skull, such as cleft lip or cleft 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 will usually draw the child's growth curve on a growth chart . Children with growth hormone deficiency have a slow or flat rate of growth. The slow growth may not show up until a child is 2 or 3 years old.

The child will be much shorter than most children of the same age and gender. The child will still have normal body proportions though body build may be chubby. Often the child’s face looks younger than children of the same age. The child will usually have normal intelligence.

In older children, puberty may come late or may not come at all, depending on the cause.

Exams and Tests

A physical examination, including weight, height, and body proportions, will show signs of slowed growth rate. The child will not follow the normal growth curves.

Hand x-ray can determine bone age. Normally, the size and shape of bones change as a person grows. These changes can be seen on an x-ray and usually follow a pattern as a child grows older.

Testing is usually done after the  pediatrician has looked into other causes of poor growth. Tests that may be done include:

Growth hormone causes the body to make insulin-like growth factor (IGF1) and insulin-like growth factor binding protein 3 (IGFBP3). Tests can measure these growth factors.Accurate growth hormone deficiency testings involves a stimulation test . This test takes several hours.

MRI of the head can show the hypothalamus and pituitary glands.

Tests to measure other hormone levels may be done because lack of growth hormone may not be the only problem.

Treatment

Treatment involves growth hormone shots (injections) given at home. The shots are usually given once a day. Older children can often learn how to give themselves the shot.

Treatment with growth hormone is long-term, often several years. During this time, the child needs to be seen regularly by the doctor to ensure treatment is working and to change the dosage of the medicine if needed.

Serious side effects of growth hormone treatment are rare. Common side effects include:

  • Headache
  • Fluid retention
  • Muscle and joint aches
  • Slippage of the bones at the hip

Outlook (Prognosis)

The earlier the condition is treated, the better the chance that a child will grow to near-normal adult height. Many children gain 4 or more inches over the first year and 3 or more inches during the next 2 years. The rate of growth then slowly decreases.

Growth hormone therapy does not work for all children.

Possible Complications

Left untreated, growth hormone deficiency may lead to short stature and delayed puberty.
Growth hormone deficiency can occur with deficiencies of other hormones such as those that control:

Production of thyroid hormones

Water balance in the body

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 health care provider if your child seems abnormally short for his or her age.

Prevention

Most cases are not preventable.

Review your child's growth chart with the pediatrician at each check-up. If there is concern about your child's growth rate, evaluation by a specialist is recommended.

References

Cooke DW, Divall SA, Radovick S. Normal and aberrant growth. In: Melmed S, Polonsky KS, Larsen PR, Kronenberg HM, eds. Williams Textbook of Endocrinology. 12th ed. Philadelphia, Pa: Elsevier Saunders; 2011: chap 24.

Parks JS, Felner EI. Hypopituitarism. In: Kliegman RM, Stanton BF, St. Geme JW III, et al., eds. Nelson Textbook of Pediatrics. 19th ed. Philadelphia, Pa: Elsevier Saunders; 2011:chap 551.

Updated: 9/9/2013

Neil K. Kaneshiro, MD, MHA, Clinical Assistant Professor of Pediatrics, University of Washington School of Medicine. Also reviewed by David Zieve, MD, MHA, Bethanne Black, and the A.D.A.M. Editorial team.


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