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Boosting Kids' Growth: Hormone Guidelines

Boosting Kids' Growth: Hormone Guidelines

Explore key guidelines for using growth hormone therapy in children with constitutional growth delay. Learn about diagnosis, assessment, and treatment goals to improve growth and psychosocial outcomes.

Guidelines for Considering Growth Hormone (GH) Therapy in Children with Constitutional Growth Delay (CGD)

Diagram illustrating characteristics of CGD

  1. Confirm Diagnosis of CGD:
    • CGD is characterized by a normal growth velocity but delayed bone age and delayed puberty compared to peers.
    • Rule out other causes of short stature such as growth hormone deficiency, chronic illness, genetic syndromes, or endocrine disorders.

Diagram for growth and pubertal stages

  1. Growth and Pubertal Assessment:
    • Height significantly below the 3rd percentile for age and sex.
    • Growth velocity within normal limits for CGD.
    • Bone age delayed by at least 2 years compared to chronological age.
    • Delayed onset of puberty (typically beyond 13 years in girls and 14 years in boys).

Timeline showing typical growth patterns in CGD

  1. Failure of Spontaneous Catch-up Growth:

    • Consider GH therapy if spontaneous catch-up growth has not occurred by mid to late adolescence.
    • Typically, lack of significant growth acceleration after expected pubertal onset age.

  2. Psychosocial Considerations:

    • Significant psychosocial distress due to short stature and delayed maturation.
    • Impact on quality of life, self-esteem, and social functioning.

Illustration showing growth hormone stimulation testing

  1. Growth Hormone Testing:

    • Usually, GH levels are normal in CGD; however, stimulation tests may be done to exclude GH deficiency.

  2. Predicted Adult Height:

    • Significantly below genetic potential or mid-parental target height.
    • GH therapy may be considered if projected adult height is substantially compromised.

Infographic on age considerations for GH therapy

  1. Age Considerations:

    • GH therapy is more effective if started before the late stages of puberty.
    • Usually initiated in mid-childhood to early puberty after thorough evaluation.

  2. Treatment Goals:

    • Accelerate growth velocity to help attain genetic target height.
    • Promote timely progression of puberty.
    • Improve psychosocial outcomes.

  3. Monitoring:

    • Regular monitoring of growth velocity, IGF-1 levels, and pubertal progression.
    • Monitor for side effects of GH therapy.

  4. Informed Consent:

    • Discuss with family and patient the benefits, risks, duration, and cost of therapy.