With the improvement of living standards, the average height of children has also increased significantly, but many parents still feel that their children cannot reach their “expected height”.
In fact, most of them are normal, but there are still some short statures caused by lack of human growth hormone. At this time, attention should be paid to avoid missing the best expectations. Let us understand the drug that can make children grow taller-growth hormone.
Human growth hormone is divided into endogenous and exogenous.
Endogenous growth hormone is secreted by growth hormone secreting cells in the anterior pituitary gland, and exogenous growth hormone is recombinant human growth hormone synthesized in vitro by genetic engineering technology. The synthetic recombinant human growth hormone has the same effect as the human endogenous growth hormone. The same role as hormones.
Stimulate the differentiation and proliferation of epiphyseal chondrocytes, stimulate the growth of cartilage stromal cells, stimulate the differentiation and proliferation of osteoblasts, and cause acceleration of linear growth and widening of bones.
Recombinant human growth hormone was first approved by the US FDA for growth hormone deficiency in 1985, and it has been approved for use in chronic renal insufficiency before kidney transplantation, idiopathic short stature, small for gestational age, and Turner synthesis Syndrome, noonan syndrome, Prader-Willi syndrome, etc.
Since the advent of recombinant human growth hormone, it has brought hope for the treatment of children with short stature. The following introduces 8 clinical applications of recombinant human growth hormone.
Growth hormone deficiency is due to insufficient growth hormone secreted by the pituitary gland, resulting in short stature in children.
However, growth hormone deficiency lacks the gold standard for diagnosis, and human growth hormone drug provocation test is currently an important basis for clinical diagnosis of growth hormone deficiency. However, this test still has certain limitations because it has a certain false positive rate and is difficult to be used as growth hormone. The gold standard for the diagnosis of deficiency should be comprehensively diagnosed.
The basis for auxiliary diagnosis also includes ①The height is lagging behind the 3rd percentile of the height of normal healthy children of the same age and sex or less than 2 standard deviations; ②The height of children under 3 years of age is less than 7cm/year, from 3 years old to prepubertal <5cm/year, puberty (12~13 years old for boys, 10-11 years old for girls) <6cm/year; ③Symmetrically short, naive face; ④Bone age lags behind the actual age; ⑤The serum insulin-like growth factor 1 level is lower than normal Wait.
Growth hormone deficiencies should be treated with growth hormone replacement therapy as soon as possible, starting from the age of 3, and adhere to the long-term, continuous, and individualized treatment principle.
Idiopathic short stature (familial, constitutional delayed puberty) refers to those who exclude growth hormone deficiency, small for gestational age, systemic diseases, etc., but the height of the child is lower than the average height of the same sex, the same age, and normal children 2 standard deviations; its essence is a group of short stature diseases whose causes are currently unknown.
Growth hormone is used to treat idiopathic short stature. It is recommended to start treatment at 5 years old and use it until early puberty.
At present, it is mostly believed that babies who are small for gestational age refer to newborns whose birth weight and/or length are lower than the 10th percentile of the normal reference value for the same gestational age; or indicate that the birth weight is lower than the normal reference value for the same gestational age-2 standard deviations Or the 3rd percentile newborn.
Most children who are small for gestational age achieve catch-up growth after birth, and can reach the height of normal children of the same age and sex;
However, there are also a small number of failures to catch up with growth. It is recommended in China that for children younger than gestational age who fail to catch up with growth, if the height of> 4 years old is still lower than the average height of the same age and gender of normal children -2 standard deviations, recombinant human growth hormone can be started treatment.
Turner syndrome is a rare genetic disease, which belongs to chromosomal abnormalities and can be diagnosed by chromosome karyotype analysis.
Such children have lagging in length and weight at birth, and their growth is significantly slower after the age of 2 to 3 years, and the lagging behind is more obvious after the normal adolescent age. The height of adults with Turner syndrome is about 20 cm shorter than the average value of normal people. The final adult height of untreated children with typical Turner syndrome is about 135-140 cm.
Noonan syndrome is a genetic disease with multiple congenital malformations. The karyotype of the child is normal. 80% of Noonan syndrome is accompanied by congenital heart disease, mainly right heart system disease.
Children with Noonan syndrome are usually born with normal length and weight. After birth, growth retardation, short stature, backward bone age, chicken breasts, etc. appear.
Prader-Willi syndrome is a syndrome caused by abnormal parents’ genes, also known as obesity syndrome. The main clinical manifestations are: feeding difficulties in infancy, low muscle tone, lagging growth in early childhood, hyperappetite, obesity, mental retardation, and lagging gonadal development.
Recombinant human growth hormone can be combined with gonadotropin-releasing hormone analogs (such as triptorelin) in children with precocious puberty and short stature. Triptorelin can reduce the synthesis of sex hormones, delay precocious puberty, and inhibit children’s development. The rapid progress of bone age and the early closure of the epiphysis will extend the bone growth period and increase the final adult height of the child.
Growth hormone can increase ovarian responsiveness, promote endometrial growth, and improve the effect of ovulation induction therapy in patients with low ovarian response. Therefore, growth hormone-assisted ovulation therapy for patients with low ovarian response can increase the clinical pregnancy rate of in vitro fertilization-embryo transfer.
The influencing factors of children’s height mainly include genetics and environment, as well as hormone regulation during growth and development, so the reasons for short stature are varied.
Before using growth hormone therapy, you need to clarify the cause and do not use it blindly. Go to a regular hospital for examination and treatment. In addition to looking at bone age and blood sampling, related examinations should also be done with pituitary magnetic resonance, liver and kidney function, blood sugar, hepatitis B Two-and-a-half detailed examinations, rule out some factors that are not suitable for the use of growth hormone.
Growth hormone can reduce insulin sensitivity and can cause transient hyperglycemia, which usually returns to normal with prolonged medication or after medication is stopped. Particular attention should be paid to patients with family history of diabetes and obese patients.
In addition, growth hormone can cause aggravation of thyroid disease, and thyroid function needs to be monitored during treatment with growth hormone.
The effects of growth hormone therapy on the bones mainly include scoliosis and femoral head slippage. The rapid increase in height can accelerate the progress of scoliosis.
Therefore, routine clinical examination of the spine is required before and during growth hormone treatment. Such as the use of high-dose growth hormone therapy can also lead to accelerated bone maturation.
Common symptoms include transient skin reactions (pain, numbness, redness, etc.) and fluid retention (peripheral edema or myalgia). These side effects occur earlier, but the incidence decreases with the prolonged medication time, and rarely affects daily life.